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Ethical Issues and Considerations in the Use of Technology

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Janis Raguin

on 12 October 2014

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Transcript of Ethical Issues and Considerations in the Use of Technology

ACA Code of Ethics, Section H
Ethical Issues and Considerations in the Use of Technology
Ethical Implications
Legal Implications
Distance Counseling
Ethical Implications
Technology: Virtual Reality in Counseling
Security and Confidentiality
Clinical Implications
Clinical Implications
Legal Implications
Client Records
Ethical Implications
This section is brought to you today by the letters
Ethical Considerations
in the Use of Technology
An approach to counseling that encompasses traditional practices through the use of electronic means
email, skype, chat, phone, stand-alone, video conferencing or stand-alone software programs
possible to have a distance counselor from another state or country

H.2 Informed Consent
H.3 Client Verification
H.4 Distance Counseling Relationship

H. 1. b Laws and Statutes
Understand that they may be subject to laws and regulations of both the counselors practice location and clients place of residence
Counselors must ensure that their clients are aware of pertinent legal rights and limitations governing the practice of counseling across state lines or international boundaries

Massachusetts Laws On Distance Counseling
Policy No. 07-03
The services offered by licensees of this Board across distance by electronic means, fall within the jurisdiction of the Board just as traditional face-to-face services do. Therefore all Board policies & regulations apply to these services.
Distance Delivery of counseling and therapy is considered to occur in two locations: Where the client is located and where the clinician is located
Therefore, the provision of counseling and/or therapy to individuals located within MA at the time services are occurring, are considered to fall under the jurisdiction of the Board, regardless of the location of the provider
Mental health professionals licensed by any jurisdiction other than MA, and not licensed by any MA board or not eligible for an exception to MA licensure, are considered unlicensed by this Board for practice in MA
Mental health professionals licensed by other jurisdictions who wish to provide services to clients within MA, are encouraged to apply for MA licensure
Board licensees who wish to provide services via. electronic means to clients located outside of MA are urged to ensure that they meet the requirements for practice within the jurisdiction where the client is located
Greater comfort for those who are highly anxious in social situations
People who are disabled or housebound
Offers access to mental health professionals to people who live in remote or rural areas
People who wish to have a therapist who speaks the same language or is from the same culture
More convenient
Most insurance companies do not cover online therapy
Not appropriate with severe mental illness/ misdiagnosis
Difficult to respond to crisis situations
Lacking the benefits of traditional face-to-face therapy
S & M
Social Media
VRT is a method of psychotherapy using virtual reality technology including head mounted displays and data gloves with position trackers.
Psychologists predict the use of VRT will be the third most likely intervention to increase and change the future of counseling (Norcross, Hedges & Prochaska, 2002)
VRT is used with anxiety disorders such as fears, phobias and post traumatic stress disorder (Meyerbroker & Emmelamp, 2010)
It is also used in non-anxiety conditions such as eating disorders, pain management and sexual disorders (Riva, 2009)
The key to its success is the ability to create real experiences so vividly that they evoke comparable and real emotions thereby opening the opportunity for exposure therapy.
(ACA, 2014) Standard C.2.a, "Boundaries of Competence-Counselors practice only within the boundaries of their competence, based on their education, training, supervised experience, state and national professional credentials, and appropriate professional experience"
Competence is an ethical concern. Because this is a relatively new technology, there are very few that can supervise VRT adequately. VRT should only be used by thoroughly trained clinicians.
Creating new memories for the client is an ethical concern. VRT could be used positively to help with unpleasant or difficult memories and replace them with a more positive memory, yet one must question the ethical nature in doing so. Similarly, a therapist could implant a memory that creates an ongoing problem for the client and perhaps encourage a dependency on the therapist and counseling.
Another ethical issue is the question of who is developing the virtual reality technology and thus making money from its sale? Some new VR firms actually double as outpatient clinics.

H.1.a Knowledge and Legal Considerations
Counselors must develop knowledge and skills regarding related technical, ethical and legal considerations (e.g., special certifications, additional course work).

H.4.c Technology-Assisted Services
Counselors must make reasonable efforts to determine that clients are intellectually, emotionally, physically, linguistically, and functionally capable of using the application and that the application is appropriate to the client's needs. Counselors verify that clients understand the purpose and operation of the technology and follow up to correct possible misconceptions and assess subsequent steps.
Clients can relive traumatic memory without having to go back to the original site thereby exposing them to triggers and eventually reducing their stress through exposure therapy.
Unlike traditional cognitive behavior therapy, VRT can adjust the virtual environment by adding controlled smells or vibrations, and allow the clinician to determine the triggers and triggering levels for his/her client.
Some VR rehabilitation equipment is portable and can be used in people's homes. This is especially useful for patients with agoraphobia.
VRT has a high success rate with PTSD patients based on sound research (McLay & Murphy 2014). Most VRT is performed in military hospitals.
VRT technology is very expensive; although prices are coming down thanks to hardware and software advances in the gaming industry.
Prolonged exposure to technology can lead to VR sickness. Symptoms include vertigo, motion sickness, flashbacks and excessively nervous and antisocial behavior.
Critics say recreating a VR scene may backfire and reliving an event could further traumatize a patient. Others argue that recreating a VR scene oversimplifies reality and replaces critical human contact.
a. Virtual Professional Presence

b. Informed Consent

c. Client Virtual Presence

d. Use of Public Social Media

ACA Codes Section H.6

Social Media

The ACA suggests maintaining a separation

between professional websites and personal

websites making sure there are clear

distinctions between the two.

Virtual Professional Presence
Ya Gotta Keep Em Separated…
Nancy can continue counseling despite having moved away
There may be challenges to not meeting face to face
Issues might arise with technological failures
Important to think through

Informed Consent
Counselors respect the privacy of their client’s presence on social media unless given consent to view such information





Client Virtual Presence
Counselors take precautions to avoid disclosing confidential information through public social media

Use of Public Social Media
H.2.d. Security
Counselors use current
standards within their websites and/or technology-based communications that meet applicable legal requirements. Counselors take reasonable precautions to ensure the confidentiality of information transmitted through any electronic means.
H.5.a. Records
Counselors maintain electronic records in accordance with relevant laws and statutes. Counselors
inform clients on how records are maintained electronically
. This includes, but is not limited to, the type of encryption and security assigned to the records, and if/for how long archival storage of transaction records is maintained.
B.6.e Client Access
provide reasonable access to records
and copies of records when requested by competent clients. Counselors limit the access of clients to their records, or portions of their records, only when there is compelling evidence that such access would cause harm to the client. Counselors document the request of clients and the rationale for withholding some or all of the records in the files of the clients. In situations involving multiple clients with only those parts of records that relate directly to them and do not include confidential information related to any other client.
H.2.b. Confidentiality Maintained by the Counselor
acknowledge the limitations
of maintaining the confidentiality of electronic records and transmissions. They inform clients that individuals must have authorized or unauthorized access to such records or transmissions (eg., colleagues, supervisors, employees, technologists).
Studies on the client's experience in therapy has showed that those who seek therapy greatly value a sense of agency in the counseling process. They note that they feel successful when they are taking an active role in therapy and can work collaboratively with their therapist.
(Hoener, Stiles, Juka & Gordon, 2012)
Would knowing that your clients have access to your notes change the way you write them? How?
Can you see any benefits to allowing your clients access to their notes? How could this be harmful? To you? To the Client?
Will this have an impact on your face-to-face sessions?
clients be given access to their records? Will all clients want access?
The release of session notes could allow for a whole new level of client agency, collaboration, and communication, but what are
the ethical implications of this?
(Beth Israel Pilot Study and Newton Psychologist)
"Encryption works. Properly implemented strong crypto systems are one of the few things that you can rely on. Unfortunately, endpoint security is so terrifically weak that NSA can frequently find ways around it." - Edward Snowden
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