___________________________________ Code of Ethics for Counselors and Marriage and Family Therapists
• Counselor bias, emotions, personality, and other factors specific to the counselor that may have impacted their practice during the service delivery. • The dynamics of the counselor/client relationship. • Review of evaluations, goal achievement, and client satisfaction with the outcomes and success of the service plan. SERVICE DELIVERY THROUGH TECHNOLOGY AND SOCIAL MEDIA The major area of revision in the ethics codes involves the use of technology in delivering counseling and therapy services. Technology has led to many complicated ethical issues in mental health service delivery in and beyond the office setting. Virtually every office and agency have sophisti- cated databases that contain an infinite amount of sensitive personal information. These systems collect, file, preserve, search, share, tabulate, track, transmit, and store information at incredible speeds with no geographic boundaries. A review of the literature reveals that even before the Internet, mental health professionals in the 1960s expressed concerns about the potential risks to individual privacy and confidentiality inherent in computerized data systems. Computer networks are used to manage records concerning assessment and evaluation, treatment, billing/payments, and communications between therapists and their clients. Many practitioners deliver services via real-time distance technology. The ever-expanding use of new technology systems, such as mobile media devices, computers, e-mail, faxes, cell phones, video conferencing, and social media may lead to breaches in confidentiality and potential ethical dilemmas. Technology in counseling settings requires ongoing security considerations to avoid new risks for unintentional confi- dentiality breaches. Counselors must carefully review their association’s and employing agency’s ethical guidelines prior to implementing technology-based therapy or counseling. Technology is continually changing, increasingly varied, com- plex, and in demand by many clients and practitioners who prefer audio/video conferencing with increased speed capaci- ties for information transmitting, and storing, over traditional methods of service. Skype, instant messaging, face time, e-mail, social media, mobile media using iPad and iPhone, and other technology methods for delivering distance practice expand the access to counseling and may make it more convenient for the client and professional. Many clients are more comfortable with online distance ser- vices than with traditional, in-person counseling because they provide more anonymity and privacy, avoiding the stigma of going to an office for services. These individuals may access and continue online counseling when they would not have done so in a face-to-face setting, which may increase that number of clients receiving services.
Technology presents many challenges to the counselor or therapist, including the following: • Counselors, therapists, staff, and clients may lack competence in using technology. Training must take place prior to service delivery requiring additional time. • Frequent system failures may block or interrupt services altogether. • During a time of crisis, it can be stressful and dangerous if a connection is lost, or service is unavailable. This may cause the counselor to lose all contact with the client. • The practitioner may receive multiple messages from different clients simultaneously. • Guidelines and boundaries must be established concerning times, length, and frequency of contact between the practitioner and client. • Communicating at a distance, especially on devices that do not have a video component, may impact the client’s authentic response and interfere with relationship development between practitioner and client. • Third parties may hear or see interactions, which erodes privacy and privilege. All of the professional counseling and therapy associations in this course detail their ethical and legal obligation to keep records secure and have developed guidelines specific to tech- nology, social media, and distance service delivery. In addition to the ethics codes, practitioners must comply with the HIPAA Privacy Rule. This rule dictates the “who, what, when, where, why, and how” of storage, transmission, disclo- sure, right of privacy, and the duty to safeguard confidential information under penalty of federal law. Distance technology includes other challenges when compared to conventional therapy. The professional may have more dif- ficulty assessing body language including facial expressions, gestures, voice quality, tone, mood, and other subtle cues that do not translate well, if at all, depending on the technology being used. The practitioner and the client should discuss and agree on a plan to evaluate the therapy’s effectiveness in the treatment plan. Either party may determine that long-distance service may be terminated or altered if not effective or if the welfare of the client is at risk. Service delivery may include a combination of distance and face-to-face methods. Ethical concerns and potential risks associated with technology cannot be completely avoided in practice today. The ethical codes, state and federal regulations, and case studies described in this course, serve as a starting point for counselors and therapists to deepen their understanding of ethical use of technology and social media in their specific area of practice. All practitioners must review their state statutes, employer guidelines, revised association codes, and HIPAA requirements
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