To Friend or not to Friend

Technology is designed to make things easier and more accessible. But counselors caution that technological advances can also usher in ethical unknowns. Laura Hahn, a private practitioner who offers counseling and consulting services in Atlanta, says the Internet can blur the boundary lines between counselors’ personal and professional lives. Many counselors have professional websites and social media pages while also maintaining a personal presence online. Hahn says it’s important to keep the two identities separate.

Hahn, an ACA member who presented on “Ethics and Technology” at this year’s ACA Annual Conference, points out that counselors have greater control over information they publish themselves, making it easier to keep boundaries intact. But they have less control — and might even be unaware of — information that others publish, such as photos posted by their friends. Hahn says it’s important for counselors to know what’s available about them on the Internet because their clients may be reading things posted not only by the counselor but about the counselor, including information ideally meant to be personal in nature. She advises that counselors regularly conduct a Google search on themselves to monitor what comes up in the results.

Counselors should also take steps to keep personal and professional information separate, Hahn says. “On a social network site like Facebook, use a ‘Page’ to display professional information and use a ‘Profile’ to display personal information. The page allows you to publish information for client use and does not have friends associated with it,” she explains.

The 2005 revision of the ACA Code of Ethics took place prior to social networking’s explosion in popularity and doesn’t address the topic directly, says ACA Manager of Ethics and Professional Standards Erin Martz. That means social networking can quickly become an ethical conundrum for counselors. Martz says sites such as Facebook should be treated as social interactions even though they’re virtual. The deciding factor then should be whether the interaction benefits or harms the client, she says. Martz points counselors toward Standard A.5.d. of the ethics code, which addresses Potentially Beneficial Interactions.

Goodnough agrees that Facebook represents uncharted territory for many counselors. “The ethical downside involves the blurring of personal and professional boundaries that can result when clients and counselors, as well as counselor educators and students, are ‘friends,’” he says. “While counselors typically refrain from [traditional] friendships with their clients, the threshold for online friendships differs in some people’s minds. Additionally, on Facebook, status updates can be reposted to another page, thus allowing friends of friends and, thus, potentially, clients or students, to see personal information and vice versa.”

Hahn simply suggests refraining from “friending” clients on Facebook. “Make it a policy by adding a statement to your informed consent documentation, and inform your clients up front,” she says. Counselors who find clients being overly interested in the counselor’s personal life and conducting intrusive online searches can explore that topic with the client in therapy, she says.

Counselors should be mindful of the content of everything they write, whether in an e-mail, a text message, a Facebook post or any other electronic communication, Hahn says, because the messages can be reposted or forwarded to those not originally intended to be recipients.

Goodnough agrees that counselors should proceed with caution when it comes to technology, especially as it relates to social networking. “There’s a whole new way that individuals and counselors interact with each other,” he says. “It’s not entirely clear what the best way [is to handle those interactions to] ensure that professional standards and ethical guidelines are enforced or that they live in those venues. We have to always recognize that we’re counselors. Even in our private role, people know us as counselors. Caution and being conservative is always called for.”

Hahn suggests that counselors looking to create a web presence for their professional practice should first read Standard A.12. (Technology Applications) of the ACA Code of Ethics to make sure they’ve done their homework before launching a website or networking page. For those counselors already online, Hahn recommends rereading the code to ensure that everything they have online is ethically sound.

Technology also expands accessibility to counseling, whether through videoconferencing services such as Skype, instant messaging, e-mail or another form of technology. Offering counseling services online connects people with therapy when they might not otherwise be able to head to a counselor’s office, Barnett says.

But if the benefit is that technology expands access to counseling for greater numbers of people, Barnett says the shortcomings can include a lack of visual cues when e-mailing or instant messaging and technological difficulties, especially with videoconferencing, such as when the video freezes or the connection is lost. “When you’re conducting a counseling session and that happens and the person is grieving or depressed, that’s not good,” Barnett says. “When you’re in the room with them, that can’t and won’t happen. Technology is a convenience, but it can also have drawbacks.”

Barnett suggests creating an electronic communication policy that details the plan for what will happen if the connection is lost. Standard A.12.g.8. of the ACA Code of Ethics supports his point, suggesting counselors should “discuss the possibility of technology failure and alternate methods of service delivery.”

Hahn says two additional ethical gray areas with online counseling include how the nature of the therapeutic relationship might be changed when the counselor and client aren’t sitting face-to-face in the same physical space and limits to confidentiality and privacy when counseling online. She recommends discussing those potential limits in advance with clients. Standard A.12.g.1. of the ACA Code of Ethics says counselors should “address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications.”

The crisis aspect of counseling is also a concern when a counselor is working with a client from a distance. If the client is in crisis and the counselor isn’t in the same room or even the same state, that can pose a problem, Barnett says. The solution, he says, is to research the area’s resources — crisis hotlines, local hospitals, emergency centers and the like — so the counselor can help the client find local assistance quickly if the need arises. That’s also a point covered under the Technology and Informed Consent standard (A.12.g.9.), which states counselors should “Inform clients of emergency procedures, such as calling 911 or a local crisis hotline, when the counselor is not available.”

Barnett recommends that counselors offering online counseling of any kind provide thorough informed consent so clients will understand the pros and cons, risks and benefits of the process. Also set out a clear fee structure, he says, including whether e-mail is charged based on the time the counselor spends in responding or by the number of lines.

In addition to having the clinical competence to address a wide variety of topics with online clients, it’s also important to be technologically competent, Barnett says. Before proceeding, he adds, counselors should be sure they have the right technology and know how to use it effectively.

Also important, Barnett says, is that counselors are both licensed and competent to provide the services they are offering online, just as they would be if offering those services in person. Even if counselors are licensed in the state where they are giving the advice, it can be problematic if they aren’t licensed in the state where the client is receiving the services, he says.

That’s true, Martz says. Although regulations can vary from state to state, most states do not allow counselors to provide counseling services — virtual or in person — unless the counselor is licensed in the state where the client is located. Because ethics are tied directly into following the law, Martz says that ethically, counselors offering services to a client in another state need to find out what the laws are and follow them.

This information is copied from http://ct.counseling.org/tag/ethics-legal-issues/ (January 7, 2014)