By Gary Schoener April 5, 2012 Walk-In Training Institute

1. CONSULTATION &
TRAINING INSTITUTE
Professional Ethics:
Facing some new challenges
April 5, 2012
Presented by:
Gary R. Schoener, M.Eq., Licensed Psychologist
Director of Consultation & Training

2. Ethical Framework
• Beneficence– doing good; helping
• Non-maleficence –avoiding harm
• Autonomy – client’s input and role
• Fidelity– consistent with what promised
• Justice-- welfare of client vs. others (e.g.
duty to warn); equitable use of resources –
having a basis to proportion them

3. Ethical Decision-Making
• It is often not what is ethical vs.
unethical, but the comparative ethicality
of the options
• This involves weighing which principles
are best dealt with through one option or
another
• What are the likely positive vs. negative
outcomes of choosing a given course of
action?

4. Decision table or chart
Positive Outcomes Negative Outcomes
Option A ______________ _________________
______________ _________________
______________ _________________
Option B ______________ _________________
______________ _________________
______________ _________________

5. Electronic records
• As of 23 January 2012 US major healthcare information
privacy breaches are 19 million records in 385 major
HIPAA - reported incidents (each affecting 500 or more)
since Sept. 2009 (2 ¼ years)
• Minn. Attorney General Lori Swanson has announced a
lawsuit against Accretive Health Inc., a debt collection
agency, or its role in a breach impacting 20,000 patients
at North Memorial Health Care & Fairview Health
Services. Data was on an un-encrypted laptop stolen
from a parked rental car.
• It is recommended that all devices be encrypted, even
those which are not supposed to be used to transport
data, since people get careless

6. Challenges of private knowledge
• CASE 1: You have a case with severe
abuse. You visit your sister and notice the
family lives next door, and her kids are
going over to play in the abuse house.
What actions do you take if any?
• CASE 2: Your brother brags to you how he
fooled child protection into closing a
case, by threatening his wife and kids to
deny the complaint. What action options
are there? What if any should you take?

7. Traditional Boundaries with
regard to Information Access
• Clienthas access to information about the
professional based on published biography
or revelations, news items
• Professional only has access to
information about client from disclosures
or access granted through signed releases

8. Variability between staff in
community programs
• Role – staff who are in the community
with client or who spend more time with
client
• Client expectations depending on role
• Do you transport the client?
• Recovery groups
• Where do you live?
• Other areas of social activity, politics

9. Realities of a small community
• You and client belong to same church, same
social club, same athletic club
• Client lives in same building as a friend of
yours – what are the issues?
• Client interacts with a member of your
family, possibly without knowing the
connection;
• Former client interacts with you or a friend or
family

10. Traditional Concepts of
Communication
• Communication by traditional mail (now
called “snail mail”);
• Communication by phone during limited
business hours;
• Leave messages on answering machinesfor
later response;
• Phone calls private, although a message left
might be saved;
• Quick response not expected or promised

11. Communication in today’s world
• Expectation of being able to connect at all
hours, even when professional is away
from office, via cell phones, texting, etc.
• Same is true for emails;
• Emails and text messages create a record;
• Emails can be misdirected or examined by
others– need to warn people about
employer access to work computers

12. Challenges of Cell Phones
&Hand-Held Devices
• Do you have separate personal &
professional phones/blackberry’s, etc? it’s
a challenge to have two, but a growing
number of programs are providing them
• Do you accept or receive calls? Is your
number blocked? Will your call be
accepted if you are trying to contact
client? Can client get your home #?

13. Text Messaging
• A growing number of people do texting
instead of (or in addition to) emailing;
• This is an abbreviated type of message
with less information;
• This the only way to quickly reach people;
• Unlike a phone call, it is silent, so people
can receive and view a text without the
ring of a phone

14. Text Messaging (continued)
• Veterans Crisis Line (800) 273-8255 or text
to 838255http://veteranscrisisline.net
• Crisis Connection has a program for
texting in 7 counties in northeast Minn. –
they are receiving more texts from young
people in a day than they previously
received as phone calls in a month.

15. Smartphones & Tablets & Apps
• The Therapist May See You
Anytime, Anywhere (NY Times, 2/13/12)
• Cognitive bias modification (CBM)using
an app for social anxiety which directs
attention away from hostile faces
• Nader Amirat San Diego State – 30”/week
for anxiety disorder
• Daniel Pine at NIMH – 40 children with
chronic anxiety

16. Smartphones & Tablets & Apps
• European psychologistshave tried a BMP
aimed at heavy drinking – people pushed
away images of alcoholic drinks & zoom in
on non-alcoholic ones – aids therapy
• How to decide an recommending an app
• How and when to ask client to use an app
• Implications of doing this with an app that
the therapist designed or invented or sells

17. New Hazards
• Client messaging about things during
session/activity – distracted? In group is
there a breach of confidentiality?
• Cell phones can film sessions – Staff
privacy rights?
• 63% under 30 drove while using hand-held
phone; 30% texted
• 5,500 people in US were killed in
distracted driving accidents in 2009

18. Social Networking Sites
• Facebook -- >500 million users
• 92% of SNS users are on Facebook;
• 50% log in on any given day;
• Facebook – “friend” vs. “deferred”?
• Posts from you, friend, relative, kid
• 29% use MySpace; 18% Linkedin;
• 50 million Twitter – 13% of SNS

19. Personal Exposure
• CASE 3:Professional has gone through a
divorce – something his/her clients don’t
know – they presume he/she is married
• Some clients are working on issues of
relationship fidelity, etc.
• Professional wants to sign up for a social
dating site, but is worried that a client will
be asked about dating them
• What options are there?

20. More visibility issues
• If you use a family photograph on
Facebook, even with the highest privacy
settings people see that photo;
• Even if you don’t show your family to the
world, friends or family may show your
photo or a family activity;
• 90% of US physicians are on Facebook or
Linked in or some social media.

21. Hazards Never Imagined (for staff
or even clients)
• Happy slapping– assaulting someone while
others film it (usually on cell phone)
• Sexting – sending racy photos of yourself or
someone else
• Filming and/or broadcasting a party, or other
event
• Live broadcast using cell phone or camera
(privacy invasion case – Tyler Clementi suicide
at Rutgers – Dharun Ravi, age 19, convicted in
Feb. 2012. Awaiting sentencing)

22. Hazards Never Imagined (cont.)
• Fake profiles
• Internet harassment – which can lead to
great distress the same as any type of
bullying (1/3 to 1/2 of adolescents?);
• Fake emails & chat screen names– so one
can harass secretly;
• Massive Defriending– being shut-out by
groups of friends or classmates on a social
networking site such as Facebook

23. Undressing your Friends (or
enemies)
• FalseFlesh.com, billed
as “adult image editing
software” allows you to
paste someone’s face
onto a nude body
• “Easily make any
picture a nude picture
in minutes”

24. Cases to lose sleep over
• Draker v. Schreiber(2006, 2008) two
students created My Space site with fake
photos trashing Asst. Principal – Anna
Drakersued them and their parents
without success;
• Megan Meier, driven to suicide by “Josh,”
created by the mother of a girl she was
having a dispute with;

25. Cases (cont.)
• Ryan Hallingan, middle school student
with a learning disorder was the focus of
bullying & suggestions he was gay. He
hanged himself after a girl who claimed to
be his friend told him publicly he was a
“loser” and that she had been pretending
to be just like him so she could post their
conversations on line and humiliate him.

26. Cases (cont.)
• GhyslainRaza, the “Star Wars Kid,” a
Canadian adolescent made a video in 2002
pretending to fight with a light saber as a
school project. Another student posted
it, adding music, and 900 million saw it on the
web. Raza was taunted repeatedly and
dropped out of school. After treatment for
depression he got support, some from the
internet, graduated law school, and heads a
foundation for preservation.

27. Cases (cont.)
• Jesse Logan, Ohio teenager, sent nude
pictures of herself to her boyfriend. After
they broke up he sent them to other girls
who circulated them on line. She was
called a slut & ridiculed and started
skipping school. Jesse went public with
her story via a TV interview in May
2008, but two months later hanged
herself. A classic example of the dangers
of sexting.

28. Cases (cont.)
• 4/21/11 Buffalo, NY.Police invade home
with assault rifles; throw man on floor;
call him a “pervert” and “pedophile” and
confiscate all computers and cell phones in
the house including those of his wife and
daughter. He did not have a passcode on
his wireless router and it was utilized by
someone nearby to download
pornography. This can be done by
neighbor, or from a car.

29. Other networking issues
• Caring Bridge– sites related to illness:
therapist’s illness?; posting on client’s
bridge?;
• Blogs -- posting responses;
• Sites focused on special interests:
• Client alerts you to site
• You encounter client on a site
• Former client alerts you to site

30. Google & Net Research
• Should you “Google” a client?
• Emergency Situation – identity issue;
• Client denies suicide history but has prior
attempts;
• Reality check on claims by client;
• Checking on criminal justice history;
• Screening for sex offenders

31. Google & Net Research (cont.)
• What if the client googles you?
• Intern entering therapy googles her
therapist and then wonders if she’s “blown
it” by doing this.
• What if they tell you? What if you suspect?
• Sites that evaluate professionals – YELP has
>25 million hits a month

32. Google & Net Research (cont.)
• What about hiring or credentialing process
– do you google candidates?
• What about interns or candidates for
supervision?
• Do you disclose this practice?
• If you stumble on information?
• By 2010, 78% of US companies do internet
searches on applicants; 86% say it
influences hiring decisions

33. Google & Net Research (cont.)
• Clients may interact with each
other, adding complex dynamics to service
delivery;
• An angry client may create a website
attacking the counselor, or counseling, or
the program or therapeutic approach;
• “Googlegangers” – people with same
name – people can be mistaken about
identity;
• Anything on the internet could be false

34. Google & Net Research (cont.)
• Facebook refuses to shut rape page run by
schoolboy (Sunday Telegraph,10/17/11)
• Compromise of psychological tests:
• www.mindfithypnosis.com/free-mmpi2-
online
• www.hypnoticmp.3.com (Dr. Dobson)
• Wikipedia entry on the Rorschach which
shows 10 blots and reveals common
responses

35. More Internet Research Issues
• Clients & others may research
medications, treatment methods, etc. on
the internet. The impact varies with the
accuracy of what they find.
• Research has shown that searches about
medications produce different results in
the US vs. Canada – Canadians are sent to
Wikipedia & drug company sites first

36. Professional Ethics: Uncharted
Territory
• In certain circumstances there may be a
good reason to do a search of a client. Steve
Behnke, APA Monitor, V ol. 41, #7, July 2010
• Googling a patient is not necessarily
unethical – the key is that if you do it your
actions should be in the patient’s best
interest. Psychiatric News, Vol. 44, # 9, May
2009
• Ethical analysis: Examine beneficence, non-
maleficence, autonomy, fidelity, & justice
issues before doing it

37. AMA Policy: Professionalism in
the use of social media
• Refrain from posting patient information
• Privacy settings; monitor internet presence
• Appropriate boundaries with patient
interactions on internet
• Separate personal & professional content on
line;
• Confront or report unprofessional conduct
on line
• Can undermine reputation & public trust

38. Some thoughts
• The internet creates a “small town”or
ethnic subgroup for all of us;
• With some areas of work such as criminal
justice, there may be greater challenges –
clientele, role of security;
• Health care rating sitesare likely to grow
and include more therapists –
healthgrades.com, vitals.com

39. The Battleground
• Section 230 of the Communications
Decency Act: internet service providers
have no accountability for anon. posts;
• This area of law is evolving – some suggest
having contract with client;
• Firms and approaches are evolving for self-
defense www.medicaljustice.com
• Integrity Defendersworks at burying
negative information w/ positive info.

40. The Battle Over Criticism
on the Web
• Second year law student Rockstar05
founded blog Thomas M. Cooley Law
School Scam
• School sought identity of Rockstar05 to
sue for defamation – issue is privacy rights
of internet commentators vs. plaintiffs
• This case was complicated because
company that hosts blog slipped up and
revealed his email address

41. Self protection
• Be aware of your web-presence
• “Google” yourself
• If there is false information, contact site
administrator to get things changed
• Should you control on-line presence by
expanding it? Should you post your own
www.google/com/profile?
• Collegial discussion – develop standards

42. On line reviews
• It’s hard to know what they mean – they
are not systematic;
• The data about your work or practice may
be in error or outdates;
• Many times there are only a few who do a
review so there can be a heavy influence
of just a few ratings
• Consumers focus on manner –
civility, perceived warmth, etc.

43. Accountability vs. Defamation
• David McKee, Duluth, MN, neurologist
sued the son of a former patient for
defamation for statements made on
websites alleging bad bedside manner in
the treatment of his father.
• Dr. McKee was called a “real tool” and
alleged a callous attitude. This is not the
only such case. It was dismissed although
the Minnesota Supreme Court is currently
hearing it.

44. Consent and Disclosure
• What ground rules will you have for a
given unit, program, or practice as far as
googling?
• If you do “Google” someone, will you
disclose this to them?
• What rules if any will you ask clients to
follow as regards the internet?
• Will you ask them to maintain any privacy
or respect any boundaries?

45. Communications & Social
Media Policy
• Email: Email only to arrange or modify
appointments. Do not email content or
important things we should discuss face to
face…..
• Rating or review sites: Info. on them is
questionable; I cannot respond to them
and do not need positive ratings; ask me
about any concerns you have about my
services.

46. Communications & Social
Media Policy (continued)
• Text messaging: please do not use to contact
me – leave phone message for time
changes, etc.; email not as good but at ….
• Internet interaction: do not use wall
postings or other means of communication
on the internet – none are private
• Blog or Twitter: I do not follow you on either
– if there are things you want to share, bring
them to a session

47. Communications & Social
Media Policy (continued)
• Friending: It is my practice to not accept
contact or “friend” requests from clients
on social networking sites such as
Facebook or Linkedin. They can
compromise privacy and also complicate
our helping relationship.
• Website or Facebook Page: If you have
questions, bring them in a session. Please
don’t interact on the internet.

48. Communications & Social
Media Policy (continued)
• Search Engines:I do not research my
clients on Google or other search engines.
There may be occasions where you will
direct me to look up something related to
your life or experience, and if so we can
discuss it at a future meeting. If you
choose to check me out on the web I
would note that not all information is
accurate, and would suggest that we
discuss anything which you find troubling.

49. Communications & Social
Media Policy (continued)
• Recording:Unless we have specifically
discussed it, there will be no recording of
our meetings or any phone conversation.
All of our discussions are private.
• Records: I will maintain the records of our
work together as confidential although
some billing-related information may be
communicated securely. Please remember
that any notes you make can compromise
your privacy if not carefully protected.

50. Challenges for Licensure Boards
• Internet services -- How will these new
areas of knowledge and skills be assessed
for licensing purposes?
• Will Boards in any way regulate the
creation of internet – based services?
• In New Zealand there is an elaborate
website to combat depression in young
people: http://www.thelowdown.co.nz

51. Helping Clients or Staff who are
Victims of Cyber bullying
• Clarify what victim wants/needs
• Reinforce that they are not at fault
• Avoid victim-blaming by saying things like
“you just need to be assertive”
• Assist them in taking any action
• Help with any underlying problems
• Assist in improving healthy relationships

53. CONSULTATION &
TRAINING INSTITUTE
Gary R. Schoener, Licensed Psychologist, M.Eq.
Director of Consultation and Training
2421 Chicago Avenue South
Minneapolis, MN 55404
(612) 870-0565 Ext. 107
grschoener@walkin.org
www.WalkIn.org