Emerging Ethical Challenges in a Changing Landscape discusses the ethical issues that arise from providing psychological services using emerging technologies. It examines considerations around jurisdiction, privacy, informed consent, and the nature of the client relationship in a digital context. While technology progresses rapidly, psychologists must use discretion and carefully evaluate ethical and legal responsibilities for each new method of service delivery. Guidance is needed for issues like verifying a client's identity and capacity online, and ensuring ongoing care is provided at a standard of quality.

1. Emerging Ethical Challenges
in a Changing Landscape
Michael Winters, PhD & Kristin Scheel, JD

5. Technology and
Ethics

6. Is there guidance?
Emerging Ethical Challenges in a Changing
Landscape

7. What is the Internet?
US Supreme Court, Reno v.
American Civil Liberties Union,
(paraphrase):
“The internet is an international
network of interconnected
computers.”
“Email enables an individual to
send an electronic message -
generally akin to a note or letter.”
“Cyberspace is located in no
particular geographic location but
available to anyone, anywhere in
the world.”

8. What is the Legal Test?
Client’s Reasonable Expectation
Factors to Consider:
Customary Practices in Your
Profession
Your Pattern of Conduct
Disclaimers
Informed Consent
Plain Language

9. What technology?
Telephone
Teleconferencing
Voicemails
Text Messages
PDAs: Calendaring + Email
Internet
Skype
Facebook, LinkedIn, Twitter
Websites, Blogs and Forums

10. Have I considered?
Type of Communication
Jurisdiction / Licensing
Patient Privacy / Confidentiality
Quality of Care / Duty
Informed Consent / Capacity
Nature of Relationship

11. Types of Communication
Administrative Communications
Administering Psychological Services
or Treatment
Marketing (Advertising, Platform for
Public Statements, Display of
Credentials)

12. Jurisdiction / Licensing
Under the laws governing personal jurisdiction, a
psychologist who travels beyond the borders of his/her
home state to provide services to out-of-state residents
may be subject to suit in those states’s courts. US
Supreme Court says this applies even if someone has
never physically been in a particular state.
Rules of Texas Board of Examiners of Psychologists:
An individual physically located in another state is
considered practicing psychology in Texas if a
recipient of psychological services in located in Texas.
Texas license is required.
Duty to Warn: Texas vs. California (and Other States)
Limited knowledge of distant community resources,
cultural norms, local traumatic events.
Particularly helpful for clients prematurely
terminating therapy due to relocation, childcare

13. Patient Privacy / Confidentiality
Providing mental health care services online and
transferring client data electronically clearly implicates
HIPAA’s privacy requirements.
Access to electronically stored health information must
be limited to those who have a legitimate business need
to access data.
Psychologists must obtain a client’s authorization prior
to allowing anyone to use or disclose the information.
Psychologists must insure the integrity of the data.
Psychologists must confirm identities of people with
whom they communicate.
Health information transmitted over open networks
must be protected from interception.
Involuntary disclosures. Privilege is limited to protection
from disclosure of confidential information during course
of treatment.

14. Quality of Care / Duty
Can you give competent advice through the
internet?
Lack of vocal, visual and other sensory cues
Potential for equipment failures leading to
undue client anxiety, especially in crisis
situation
Periodic face to face encounters are helpful
Duty to Protect
Imminent Harm
24 Hour Hotline or Forums

15. Informed Consent
Only competent adults can give
informed consent.
How to verify age, affect, demeanor
and legal mental capacity of
anonymous online user.
Use of language that is reasonably
understandable to the client
Time
Shifts in the relationship

16. Nature of the Relationship
Mutually Established Therapeutic
Relationship
Client’s Community
Advertising Prior to Establish Relationship
Peers
Anonymous Internet Users
When providing comments via internet, or
electronic transmission, ensure that
statements are (1) based on your professional
knowledge, training or experience; (2)
consistent with Ethics Code; and (3) do not
indicate that a professional relationship has
been established with the recipient.
Consider generic responses, suggesting
community resources or follow up.

17. Takeaways
Technology is rapidly changing.
Can’t rely on law and ethical codes to
provide guidance.
We have to use discretion. A good
practice is to rely on a thoughtful
process for evaluating ethical
considerations and legal liabilities in
the use of modern technology.

18. Resources
Behnke, S. (2008). Ethics in the age of the internet. APA monitor
http://www.apa.org/monitor/2008/07-08/ethics.aspx
Clay, R. A. (2010) Expanding your reach: Facebook, Twitter and other social media tools
bring new advocacy opportunities but also new challenges. APA Monitor
http://www.apa.org/monitor/2010/05/slc-social-media.aspx
DeAngelis, T. (2012) Practicing distance therapy, legally and ethically. APA Monitor
http://www.apa.org/monitor/2012/03/virtual.aspx
Degusta, M. (2012) Are smart phones spreading faster than any technology in human
history? Technology Review
http://www.technologyreview.com/news/427787/are-smart-phones-spreading-faster-than-
any/

19. Resources
Draft of APA Guidelines on Telepsychology
http://apacustomout.apa.org/commentcentral/commentcentralPDF/Site26_Telepsychol
ogy%20Guidelines%20Draft_July2012_posted.pdf
Holland, C. (date not given) The Psychologists Legal Update 14: Psychology in the
Electronic Age.
http://www.e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=16
Spottd-Dr Lazzer, A. (2012) Losing your “mind”: What would you do in your mobile device
went missing? Psychotherapy Networker, July/August p 17-18
Zur, O. (2012). Therapeutic ethics in the digital age. Psychotherapy Networker
July/August, 26 -33.