Professional psychologists value work ethics and standard operating guidelines that are set by the American Psychological Association (APA), the National Board of Certified Counselors (NBCC), and Spanish Professional Psychology Association (SPPA) among others. The set code of conduct and work ethics determines the operation of the professional counselors and defines the acceptable behaviors of the professionals when dealing with clients. This paper looks at the ethical implications of online counseling with focus on the benefits and limitations of Internet counseling, the American Psychological Association code of ethics that sets standard operation code of conducts for its members (APA, 2002), sense-making strategies for ethical decision making that ensures that individuals make the right decisions and the ethical issues in psychologists' professional practice, with focus on agreement over problematic professional behaviors among Spanish psychologists
“So wat do u want to wrk on 2day?” The Ethical Implications of Online Counseling
This article published by the department of psychology and counseling: The University of Akron outlines the importance of Internet counseling, if worth consideration by the professional psychologists. According to Mallen and Vogel (2005), online counseling refers to the delivery of behavioral and mental health services, including therapy, consultation and psycho-education, by a licensed professional practitioner to a client without meeting face-to-face, but through the use of distance communication technologies like online websites, emails, telephone, asynchronous e-mail, videoconferencing, synchronous chat, instant message chat service, chat rooms or by use of a computer voice messaging system. This computer-based communication used for online counseling can be referred to in different terms, such as: e-mail therapy, Internet psychotherapy, tele-psychiatry, cyber-psychology, web counseling, and cyber-therapy. This can be done in asynchronous manner where time lapses between the client’s message and the practitioner’s response, or in synchronous manner, where the clinician receives the client’s message almost instantly through a chat platform in real time.
Online counseling being a new focus area, has suffered several ethical concerns that need to be addressed. Lack of ethical debate on these concerns has prompted many professional practitioners to avoid venturing in the area. Equally, other mental health practitioners started their own websites and are offering Internet psychotherapy without much ethical guidance because of the lack of standard set ethics. This article discusses the ethical issues involved in online psychotherapy and looks at its viability, benefits, and effectiveness. Because of the ethical issues surrounding Internet-based therapy, many practitioners are skeptical about it. However, there are several benefits associated with online counseling.
Benefits of Online Counseling
It allows practitioners to reach people in remote geographic locations, such as clients in rural or other outlying areas. Moving to a psychological clinic can be cumbersome, impractical or impossible for the disabled, chronically ill, or immobile patients. It also makes it possible for the patients to access professionals in the specified field who operate outside of the client’s local geographic area.
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Online counseling is also more flexible, convenient and cost-effective, since patients get therapy while in their house and without incurring movement costs. It also enables clients who prefer written to verbal communication, or those who would like to uphold anonymity, to be more open and honest with the psychotherapist in disclosing their issues than might be during a face-to-face conversation.
Online counseling is more effective when dealing with clients who do not require intense psychotherapy, but only someone to keep in touch with the psychotherapists after being transferred to other geographical areas. It is a very positive venture that psychotherapists need to fully consider, especially at this period when the world has fully embraced digital technological mode of operation. This is because most of the therapies may not need physical attendance to the patient, but rather advice on what to take and how to handle an issue. This article is, therefore, an eye opener to many clients and professional practitioners who can fully adopt this new way
The American Psychological Association (APA) Ethics Code
Online psychotherapy needs standards of operation to guide all the practitioners when handling clients online. This will also provide sanity in this field to ensure that clients are not abused and that practitioners remain professional. The APA Code of Ethics is still not precise regarding telephone therapy or teleconferencing. APA is yet to develop standards aimed specifically at online psychotherapy providers. However ethics codes developed by other mental health organizations, such as the National Board of Certified Counselors (NBCC) of 1997 and the American Counseling Association (ACA; 1999), have been more proactive in developing Internet psychotherapy regulations and standards for online counseling. This code specifies standards for the counseling relationship, legal issues and confidentiality, and has established a list of specifications that counselors need to avail to clients before engaging in online counseling. The International Society for Mental Health Online (ISHMO) is another group formed by professionals providing online services and has developed ethical values for all members of this organization.
The Ethical Concerns of Online Counseling
One of the concerns about online counseling is about the competence of the counselor and whether training is needed before one begins online counseling. Such skills may include PC proficiency, fast typing skill, accuracy and being familiar with various computer and Internet command tools, especially in relation to data security and clinical record confidentiality. Counselors should also be able to understand and use emotions, or a host of expressions created to facilitate text-based client privacy and confidentiality according to APA Ethics Code Standard 4. This would have a big implication since the counselor will not be able to match customer demand and secure clients privacy. In case this is not met, clients have the right to easily withdraw from the counseling process and the counselor may face legal consequences.
It is also an ethical lapse if the psychotherapist is incapable of validating whether the client has given false information regarding age and sex, or whether the person she/he is talking to is an adult who has the legal right to consent to treatment and not a minor. It may also be difficult for clients to verify if they are truly communicating to a mental health professional or not. In spite of the high rate of reliability, technology occasionally fails, bringing about an interruption of therapy, which is a breach of the APA Ethics Code. For the therapist to be able to accomplish effective outcome, therapy is not to be interrupted once it has been started. Conflict of state-to-state licensing laws is another concern that online counseling faces because of the unsettled jurisdiction in online counseling. In standard operations, psychotherapists practice within the state where they are licensed. Clients and psychotherapists also need to discuss the procedures of informed consent to have guidelines on what course of action clinicians or counselors are supposed to take in the event of an emergency. This will ensure clients’ confidentiality, and will enable counselors to perform appropriate risk management and assessment, practice within the confines of their license, and contact clients outside the psychotherapy room, if necessary.
This article is an educating publication that teaches people on the availability of online counseling and ethical weaknesses associated with it. The main message contained therein is to ensure that such weaknesses are eliminated. After careful evaluation of the literature and ethics codes, the conclusion made is to fully adopt online counseling, since it can be beneficial and satisfactory for clients if practiced carefully and ethically. For example, patients from remote areas can still obtain services of professionals at reasonable rates and conveniently. Practitioners, on the other hand, can reach as many clients as possible irrespective of the distance. The challenges that need to be considered here include standardization of the code of ethics to be universally identical and applicable in all parts of the world as a standard verifiable qualification that clients can can rely on to be able to tell professionals from impostors.
Breaking Confidentiality to Report Adolescent: Risk-Taking Behavior by School Psychologists
Confidentiality is one of the major ethical standards to be adhered to by psychologists when undertaking their duties. This ensures that clients’ information remains secure and confidential for the purpose of maintaining their integrity. This article looks at the views of practitioners and the circumstances under which psychologists can break the confidentiality when dealing with adolescents, especially when the client is engaging in a risky behavior. A survey that was conducted by respondents from the National Association of School Psychologists (N = 78) (NASP, 2000) involved a vignette recounting an adolescent involved in risky behaviors and ranked the level which is considered ethical to breach privacy for behaviors of changing frequency, intensity, and duration. The respondents established that it ethical to breach confidentiality when perilous adolescent behaviors appear to be more dangerous to themselves and others, although there was substantial variability between respondents. However, psychologists have an ethical commitment to uphold confidentiality within a professional relationship with students, so that self-disclosure and cooperation from students is not inhibited. Confidential information is exposed only with proper informed consent, unless in a condition in which failure to disclose information would lead to danger to a child or other individuals. This obligation to protect vulnerable parties from the harm of risky behavior is a well-outlined ethical standard in professional psychology. School psychologists must, therefore, make a decision about when to break privacy about risky adolescent conducts while maintaining professional relationship. This is done through a judgment of the intensity, frequency, or duration of risk-taking behavior and potential harm it may inflict on adolescents or other individuals.
Risk-taking behaviors associated with adolescents include smoking, drug use, alcohol use, sexual activity, suicidal ideation and behaviors which are always harmful and antisocial. They are not always classified as harmless and have the possibility of causing substantial harm to adolescents in future. On the other hand, surveyed pediatric psychologists realized that respondents view it as ethically correct to break confidentiality when risk-taking behaviors, such as smoking, drug use alcohol use, sexual behavior, and suicidal behavior, appear to be more severe and frequent or manifest themselves for a longer duration.
In a survey conducted by Isaacs and Stone, counselors were asked how they would handle privacy when involved with minors, and whether circumstances such as drug and alcohol use, physical/sexual abuse, sexual activity, and criminal behaviors justify a breach of confidentiality. Results to the survey indicated that the decision to break confidentiality depended on the professed degree of gravity of the behaviors. For example, using cocaine was considered more treacherous than smoking cigarettes. Another factor to consider as significant when deciding on whether to break confidentiality is the students’ age coupled with the likelihood of fatal consequences in case of the older students.
These surveys and the article in general, therefore, indicate that school psychologists must occasionally make a difficult decision to breach confidentiality to avert the threats posed by risk-taking adolescents that can either cause harm to themselves or other innocent students. A student under the influence of drugs may kill him/herself or another student if not controlled. For this reason, it is important that school psychologists break confidentiality to initiate rehabilitation programs. The psychologists have a backup from the ethical standards of professional psychology.
The Sidak post hoc test mentioned in the article showed significant interaction between the intensity and frequency of alcohol use, drug taking, suicidal behavior and sexual behavior as well as the duration of such behaviors. The significance of linking these divergent behaviors that can harm adolescent or others is echoed in the ethical standards of both NASP (2000) and APA (2002), since both professional organizations permit counselors to break students’ confidentiality when they engage in behaviors that are absolutely perilous to themselves or others.
Consequently, the decision to breach confidentiality to safeguard the clients from hurting themselves or others is one of the most commonly experienced and serious concerns in the practice of psychology. For example, in a case where an adolescent is HIV-positive and self-confessed to have been involved in a sexual intercourse without using a condom, the respondents are likely to find it ethical to breach confidentiality even at the lowest level of frequency and however short the duration is. Based on the school psychologists’ certainty of the ethicality of breaching confidentiality to disclose potentially treacherous behaviors, there is a need for school psychologists to expound the nature and boundaries of confidentiality to adolescent clients early during the professional relationship, to build trust at the initial stage and to avoid any misunderstandings later when the disclosure is made on the same grounds (Jacob & Hartshorne, 2007).
This initial clarification should include a discussion concerning particular behaviors that would prompt breaking of the confidentiality. Some of the guidelines provided that psychologists facing an ethical dilemma of breaking confidentiality may employ the following: (1) Explaining to the student exactly why confidentiality must be broken. This comes after initial preparation of the student for the circumstances under which privacy can be broken. (2) Discussing the likely outcomes for the student that may arise from breaking confidentiality. This will help the practitioner exonerate himself from the blames. (3) There is a need to think of the best way of breaking the confidentiality in a way that diminishes negative results for the student and to maintain the trust and relationship initially bestowed on the practitioner by the student.
Sense-making Strategies for Ethical Decision Making
This article focuses on the sense-making model and thinking strategies to examine ethical decision-making. The model outlines that environmental factors influence cognitive reasoning strategies, the reasoning strategies influence sense making, and the sense-making, in turn, influences ethical decision-making. Ethical decisions are the type of decisions that are morally correct and efficiently meet the objective for which they are intended. A number of identified cognitive reasoning strategies have been developed from the previous research that can stimulate ethical decision-making. Mumford and colleagues managed to amalgamate the list of reasoning strategies to a set of seven divergent cognitive reasoning strategies and developed these strategies to be able to promote ethicality. The strategies include;
Recognizing personal circumstances; this involves thinking about the source of the problem, the people involved, and relevant ideologies, goals, and values as well as considering one’s own role in causing and solving the problem
Anticipating consequences; involves identifying the many possible alternatives solutions and outcomes, both short- and long-term ones, based on potential decision alternatives
Considering others people’s perspectives; includes considering other people’s perceptions, concerns, and the impact of the decision made on others both socially and professionally.
Seeking help; this involves sharing with a supervisor, peers, institutional resource, or learning from the behavior of other peoples who are faced with the similar dilemma.
Questioning your own judgment; this strategy involves reviewing the opinions while taking into consideration the problems that other people often face when making ethical decisions with a view that decisions cannot be perfect.
Dealing with emotions, where personal emotions are evaluated and controlled when faced with situations that require decision-making.
Examining personal values and considering one’s own biases, effects of one’s values and goals, how to explain/justify one’s actions to others, and questioning ability to make ethical decisions.
Sense-making refers to a complex reasoning process by which an individual develops an understanding of a set of circumstances. The process of understanding an emergent situation helps individuals to figure out the causes of the situation, possible consequences of the situation and how the situation can be contained. Ethical decision-making, therefore, requires full understanding of the circumstances and weighing of all the alternatives before the best decision is made. In this case, sense-making starts when a person recognizes that something abnormal is taking place and ends at the moment the person understands the situation fully to be able to make a decision, monitor, or ignore the situation. Sense-making can be broken down into three components:
Problem recognition - this is the first step of sense-making where the individual identifies that a change has taken place and that attention should be paid to this developing situation
Information gathering - is the second stage that seeks to understand possible causes, reason for occurrence, alternative solutions to the problem and results of such an occurrence. It also involves seeking information that can assist individuals in recognizing how this condition differs from their expectations. After collecting the information, individuals can assign significance to the information and decide how essential each piece of information is. These pieces of information can then be put together to see if larger patterns can be identified.
Information integration - this involves joining the gathered information for decision-making purposes. A decision can be made regarding whether or not action is necessary. However, problem recognition is merely an act of realizing that something in a given situation is out of the ordinary. When gathering information, it is important to note that ethical events mostly involve multiple, competing goals, and as a result it is likely that those who consider fewer alternatives are more likely to take a narrow-minded or short-sighted view of the situation at hand. As a result of this, individuals are less likely to consider the long-term consequences of their actions as well as the actions of others. It is worth noting that personal preferences and situational factors can influence the way one understands their circumstances, as well as environmental forces on the individual that dictate the outcomes to be considered. The secret of making an ethical decision is to identify as many alternative solutions as possible through fully engaging and sense-making process and at the same time use cognitive reasoning strategies which promote effective and efficient information gathering and proper integration of information before the decision if finally made by picking the best alternative.
Sense-making is a very important part of decision-making process since it helps an individual to identify the importance of the emergent situation, why it differs from the norm, and what can be done to influence the consequences of the situation. The final product depends on how well situational conditions that include environmental factors are analyzed, the cognitive reasoning strategies employed by the individual and the sense-making process that is divided into three as discussed above. This brings about the ethicality of decisions made after considering all the options and finally choosing the best alternative. Other factors affecting ethical decision-making include the participants’ personality need for cognition, intelligence, planning skill, narcissism, and cynicism. These factors influence an individual’s ability to choose quality alternatives and eventually the quality of the decision made.
Because ethical dilemmas are usually unusual or ambiguous situations, sense-making is specifically relevant in making individuals understand the situation before the decision is made. In most cases, preliminary understanding of an ethically vague situation combined with the first few actions one takes, sets the path for the subsequent unfolding situation. In this case, having the skills to inspire people to be effective at creating an understanding of an ethical situation may have a far-reaching effect toward developing the type of momentum that will facilitate the most ethical resolution. This is evidenced by the three findings, i.e. when an individual considers a broad variety of issues and integrates several information were, higher ethical decision is made. It also notes that the strategies of recognizing circumstances and considering others had a remarkable impact on sense-making. Finally, ethical decisions are successful when issues are framed in terms of organizational outcomes rather than personal outcomes. A strong argument could be made that when outcomes are framed as being very personally relevant, it is likely that the individual will engage in more active cognition and develop a more effective solution to a given problem. However, as stated earlier, it is not merely the act of engaging in active cognition that is important. It is how the individual thinks about the problem while they are engaging in active cognition that matters. In this case, when the outcomes were framed as being organizationally relevant, participants utilized the anticipating consequences more effectively by, recognizing circumstances and considering others reasoning strategies.
Ethical Issues in Psychologists' Professional Practice: Agreement over Problematic Professional Behaviors among Spanish Psychologists
There are several ethical issues in psychologist’s professional practice that vary depending on different people. The aim of this article is to ascertain and learn which professional behaviors usually create ethical dilemmas for psychologists and how they respond to these issues. It is found out that psychologists who have experienced a specific dilemma are less strict when evaluating the unsuitability of a possible ethical lapse than those counselors who have not faced it.
The Spanish ethical code for the profession of psychology has recently been updated and is still undergoing revision process. The code of ethics fully conforms to the European Federation of Psychologists’ Associations (2005) directives and has a high level of agreement with the American Psychological Association (APA) code of conduct. Despite this, there are many ethical issues which psychologists show disagreement about or lack clear criteria in. This article’s study also explores most serious ethical issues for Spanish psychologists to give explanations for the divergence of views on what constitutes an ethical breach. It is worth noting that to work as a professional psychologist in Spain, an individual must have a bachelor’s degree in Psychology and belong to the Spanish Professional Psychology Association.
The basis of the dilemma that raises ethical concerns are according to the APA ethical code and the Spanish Psychologists’ Deontological Code, but that are normally welcomed by a number of professionals. There are four different areas where ethical conflict may arise. They include informed consent, abandonment, confidentiality and utilization management-utilization review. Other studies with different samples propose similar areas of conflict. Tryon (2000) stated that among psychology graduate students most ethical issues regard confidentiality, competence, and professional and academic honesty.
A critical issue within boundaries conflicts is having intimate or sexual relationships with clients. Akamatsu (1988) reported that 44.7% of the APA members condemn sexual relationship with clients. Another possibility is that practitioners are adequately trained but still have a difficulty agreeing over particular ethical issues as a result of their personal attitudes. Some believe that ethical concerns are irrelevant or too restraining in a certain situation, or that behaving according to an ethical code is not absolutely moral. For example, a situation when a lecturer advises a student to buy a book authored by him may not appear unethical to the lecturer, but the same is unethical with a claim that he is plainly promoting his book.
The ethical nature of certain behaviors will be a subject of controversy and divergence of opinions among psychologists. Many psychologists have different opinions and that the divergence between moral thinking concerning what should be done in a particular situation and actual behavior may arise from the diverse interpretations done for an evaluative or behavioral decision. An evaluative moral decision on what is right is done from the viewpoint of one’s own internal standards, and these norms are developed before the behavioral decision which is appraised from the viewpoint of the observer while considering the constraints of the circumstances and other types of standards together with moral values or, in this case, the guidelines provided by the professional code of conduct. Another source of divergence is that ethical conduct has bigger consequences than evaluative decisions on whether to act ethically or not.
Ethical dilemmas would be organized in identifiable clusters that will correspond to the different levels of discrepancy caused by the ethical situations. The dilemmas with the extreme differences between both groups were as such: using self-disclosure in therapy, charging clients for missed appointments, and charging a client no fee for therapy. The other areas that exhibit lack of consensus relate to issues of confidentiality, advertisement of services using professional qualities, clinical intervention on issues beyond one’s own specialty, and submitting possibly dangerous diagnoses to insurance companies. In particular, there was divergence of opinions on maintaining confidentiality within the family and on reporting malpractice of a colleague. Equally, non-therapists exhibited a greater tendency in upholding confidentiality than the professional group. As far as boundaries are concerned, the bulk of psychotherapists were against instigating any kind of sexual relationship with current or former patients, students, or supervisees, while patients and laypersons displayed a less severe attitude.
Work ethics is very important in any field of study and career. Psychologists who deal directly with the clients also value the standard operating ethics code that outline basic behavior expected from such professionals. Such code of ethics is outlined in the psychological associations, such as the APA, NBCC, and Spanish Professional Psychology Association among others, to guide their members on their expected conduct. In the article “The Ethical Implications of Online Counseling”, Internet counseling and therapy is encouraged due to its beneficial results both to clients and practitioners. Clients in this case can access the services of a professional at cheaper costs irrespective of the geographical distance, and also encourages clients who want to maintain anonymity to fully disclose their problems.
The second article, “Breaking Confidentiality to Report Adolescent: Risk-Taking Behavior by School Psychologists”, is centered around the possibility of a counselor breaching the confidentiality by disclosing the behavior of a client in the event the client engages in risky activities that are likely to harm both the adolescent and others. However, the level of intensity and duration needs to be specified before the level of disclosure. Professionals should also discuss with adolescents the limit of confidentiality necessary to maintain trust and relationship.
The third article titled “Sense-making Strategies for Ethical Decision Making” looks into the significance of making ethical decisions that can fully meet the objectives. This is done through sense-making strategies that help individuals fully understand the situation starting from environmental conditions and considering as many possible alternatives as possible to finally making the decision after reviewing the situation. Sensible decisions are only made through sensible strategies. Finally, the last article stipulates a number of issues bringing about dilemma among psychologists concerning ethical conflicts and boundaries practitioners need to observe when handling clients.
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