In 1990, psychologists' top ethical concerns centered on confidentiality, dual relationships with clients and questions about the amount and quality of ethics education students receive, found a national survey of APA members, published in the American Psychologist (Vol. 47, No. 3). Those concerns live on, but future psychologists will also deal with new ethical challenges and dilemmas brought about by rapid technological advancements, increasing globalization and the influence private industry can have on psychologists' research.
For example, how will you handle a client's request to "friend" you on Facebook? What precautions must you take when you use the Internet as a research tool? And how do you ensure competence when working with a client whose culture is very different from yours?
Those are among the issues cropping up more often for APA's Ethics Office, says its director, Stephen Behnke, JD, PhD. Here's advice from the experts on how to deal with them:
Online research and practice
The Internet has emerged as a powerful tool for practitioners, researchers, teachers and clients alike. Not only does it allow psychologists to gather a wide range of psychological research data quickly, it's also become a springboard for providing psychotherapy services, particularly to geographically isolated clients who would otherwise go without.
Of course, many questions remain about the validity, efficacy and safety of Internet-mediated psychological assessment and treatment, says Jeffrey Barnett, PsyD, a private practitioner in Arnold, Md., and chair of APA's Ethics Committee.
"This is an area where we really need to develop competence and not just assume that because you can effectively provide a service in person that it's going to be equivalent if it's provided over the Internet," Barnett says.
Practitioners, he adds, need to be mindful of these ethical and professional concerns when determining whether and how to incorporate the Web into their work:
Licensure and mobility issues. Psychologists may be required to be licensed in states where online clients reside.
Safety and security. When clients aren't nearby, psychologists must ensure a local mental health professional is available to provide help in emergency situations, such as when there's the threat of suicide or homicide.
Privacy and confidentiality. A broad range of technological expertise is required to ensure access to encrypted services for storing records and sending e-mails or other electronic communications.
The Internet also adds a new dimension to the ethics and validity of psychological research. Although it's inexpensive, saves time, allows for large sample sizes and participation of those from distant geographical areas, Internet research raises issues of protecting participants from unintended harm. In a 2008 article in Behavior Research Methods (Vol. 40, No. 4), experimental psychologist Kimberly Barchard, PhD, of the University of Nevada, Las Vegas, encouraged researchers to ensure ethical research online by:
Pretesting their Web site. Scientists can avoid unintended harm by pretesting their Web sites with people from the target population. This is particularly important if the study targets vulnerable populations such as children or the mentally ill, but it is also helpful when studying older adults, people from other cultures or any specialized group.
Protecting confidentiality. To ensure participant confidentiality, identifying information should be kept separate from sensitive information if possible. In addition, when sensitive data are joined with individually identifiable information in the same submission, researchers must use security measures such as encryption and secure socket layer and protect physical and electronic access to subject data.
Obtaining institutional review board approval. Remember that Internet research, just like laboratory-based studies, requires institutional review board approval.
C U online?
The Internet also poses ethical challenges through the advent of such social networking Web sites as Facebook and MySpace. For example, while at times it may be therapeutically relevant to accept friend requests from clients so that you can view their pages and integrate their artwork or writings into their treatment, connecting in cyberspace can also change the nature of the relationship and blur the boundary between professional and personal, Barnett says.
"If you're not going to talk about your vacation with your clients in a session, why would you want to grant them access to photos of your vacation with your family and you in your bathing suit?" he asks.
He recommends that psychologists:
Develop a formal policy about their involvement in social networking sites and integrate it into the informed consent process.
Establish different security levels for information intended for family and friends and that which is appropriate for anyone else who might see their page.
Ensuring cultural awareness
As America's population continues to diversify, it's more important than ever to conduct psychological research and provide mental health services that are culturally appropriate, Barnett says.
"Each disorder resides in a cultural context, and if we don't understand that context, we can be harmful," Barnett says.
One common example: Just because a psychologist speaks Spanish doesn't mean he or she has the cultural understanding to provide therapy or assessment to all Latinos, says Lynda Field, PhD, a psychologist at the Suffolk University Counseling Center and former associate member of the APA Ethics Committee.
To ensure competence and lessen bias when working with culturally diverse clients or research participants, psychologists should:
Seek out continuing education and help others to do so as well. Participate in multicultural conferences, consult with those who are more experienced with certain ethnicities, cultures, religious faiths or age groups, and follow the literature on the topic, Field says. "People have to feel safe not knowing things, and we as a profession need to create a culture that says, 'Of course we're going to make mistakes, it's important to stay humble and continue to ask, read, learn and discourse,'" she says.
Understand your limits. It's also important to know how far your knowledge extends, Field says. Education is important, but sometimes it may be best to refer clients out if you just are not able to meet their needs.
Managing financial conflict of interest
Financial relationships between scientists and industry are coming under increased scrutiny as the influence of big corporations in daily life continues to grow. If psychologists don't consider the potential conflicts of interests, they risk threatening the integrity of psychological research and practice, says Celia B. Fisher, PhD, a psychology professor and director of the Center for Ethics Education at Fordham University.
For example, she says, research psychologists can examine a hypothesis, provide data and generate knowledge regarding a particular perspective or policy that a company thinks is in its best interest, but they can't bias the data toward proving that hypothesis. In addition to flat-out falsifying or fabricating data, it is unethical to intentionally select research designs, samples or measures that restrict the range of possible outcomes to those preferred by the sponsor.
To ensure grants from private companies do not carry stipulations that could lead to ethical concerns, researchers should consult their institution's attorney about any industry contract they're considering, Fisher says. In addition, when research is industry-sponsored, psychologists must ensure that they have input into the study's design and independent access to raw data, as well as a considerable role in manuscript submission. They should also be sure to disclose financial conflicts of interests when making the information public. "Being ethical is all about preparation," Fisher says. "No matter what area of ethics you're talking about, psychologists need to be prepared."
By Amy Novotney
Amy Novotney is a writer in Chicago.
FURTHER READING, RESOURCES
To view the APA Ethical Principles of Psychologists and Code of Conduct, visit www.apa.org/ethics.
Barnett, J.E. & Johnson, W.B. (2008). Ethics Desk Reference for Psychologists. Washington, DC: APA.
Bersoff, D.N. (Ed). (2008). Ethical conflicts in psychology, Fourth edition. Washington, DC: APA.
Fisher, C.B. (2009). Decoding the ethics code: A practical guide for psychologists, Second edition. Thousand Oaks, CA: Sage Publications.
Zur, O., Williams, M.H., Lehavot, K. & Knapp, S. (2009) Psychotherapist self-disclosure and transparency in the Internet Age. Professional Psychology: Research and Practice, 40(1), 22–30.
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