Most psychologists practising today use email for professional communication, electronically store client details and use a diary on their smartphone/tablet. Psychologists are also using social media (e.g., Facebook, Twitter, LinkedIn, blogs, YouTube) for a range of professional and personal tasks such as public education, professional networking or personal communication. Even those psychologists who do not use these technologies will probably interact with clients and professionals who do. These technologies have the potential to increase the efficiency and reach of psychologists, but do raise additional ethical concerns.
To practice competently all psychologists should be aware of the potential ethical issues associated with the technological tools they use. This paper aims to assist psychologists to identify ethical issues associated with using technology as part of their practise as well as their use of social media (professional and personal). Guidance in relation to competent and ethical practice in this area is provided by the APS (Code of Ethics and Ethical Guidelines) and the Psychology Board of Australia (PsyBA).
Email communications
Psychologists need to be aware of the potential ethical issues of communicating via email. An email that is not encrypted can be accessed while it is stored on the client’s (or psychologist’s) computer or in its visible state as it transitions across the Internet to the recipient. Emails are also easily forwarded to third parties, sometimes inadvertently. These concerns mirror those of written reports about a client. However, email has potentially greater scope for breaches of confidentiality due to the ease of replication and transmission. If the client uses a workplace email system, it is likely that administrative, management or technical staff have access to the account. Similar concerns may be relevant if a family email account is used for communication.
Web-based free email accounts such as Gmail are prone to being searched by the email provider (data mining) and using information to deliver targeted advertising, often in collaboration with third parties. For example, a client who receives an email from a psychologist in relation to a gambling addiction may have the word ‘gambling’ picked up by the email provider’s search facility and subsequently be targeted with gambling advertisements on the Internet. This clearly has implications for confidentiality and while these ethical concerns are not insurmountable, they must be seriously considered before a psychologist uses email for any form of professional communication.
Electronic storage of client information
Offering ease of access and flexibility, electronic storage of client information is used by many psychologists. This can range from a spreadsheet containing client contact details, to a completely computerised paper-free storage system (e.g., paper-based assessments digitally scanned and paper copies destroyed). However, storing files in a digital format can make them more vulnerable to unauthorised access. Many digital storage devices have a five to ten year lifespan, with some prone to deteriorate more rapidly if not stored in ideal conditions. Small USB storage devices (and phones and tablets) are more easily misplaced or stolen than traditional paper-based filing systems, potentially allowing unauthorised access to confidential client information.
Ideally, electronic records should be stored on computers and devices without an Internet connection to minimise the possibility of unauthorised access (Boyle & Gamble, 2014). If this is not possible, strong encryption and password protection is essential. Psychologists should ensure that regular electronic backups are created and stored in a separate location (noting the discussion below that online ‘cloud’ storage can also be ethically problematic). The security of confidential files has always been a consideration for psychologists, and technological advances have just highlighted new concerns.
Use of smartphones and tablets
Many smartphones and tablets come with default online ‘cloud’ backup and storage systems, increasing storage space and automatically backing up critical information. This can be ethically problematic if psychologists store confidential information on their mobile devices. Although mobile devices are marketed as providing online storage, these services store information on a physical computer located internationally, which may not comply with Australian privacy legislation. Information on the location and security provisions in place to protect information is generally unavailable. This might not be of concern for most users, but presents ethical concerns for the storage of confidential client information.
Psychologists need to be aware of any client information stored on their mobile devices and ensure it is not transmitted to a third-party storage system. This can be done by choosing not to have information saved and stored via the cloud backup. For example, Apple users are able to review their global backup settings as well as customise individual settings for cloud storage of information from various applications such as mail, contacts, notes and calendars (from the home screen, click on settings > iCloud > storage and backup).
In addition, psychologists should strongly consider having separate mobile devices for professional and private use. This allows for greater protection of sensitive client information, such as audio recordings of sessions, through ensuring the secure storage of the mobile device used for professional purposes in a locked cabinet or other facility. It also reduces the chance of inadvertent disclosures, such as a psychologist’s family member accidentally stumbling across confidential information stored on a mobile device while using it recreationally.
Social media
Psychologists need to be mindful of their personal and professional use of social media and should comply with the professional expectations set out by relevant policies, codes and guidelines. The social media policy issued by the Australian Health Practitioner Regulation Agency (AHPRA, 2014), which is applicable to psychologists, states “whether an online activity is able to be viewed by the public or limited to a specific group of people, health professionals need to maintain professional standards and be aware of the implications of their actions” (2014, p.2). The AHPRA definition of social media is broad, and includes anonymous or personal blogs, personal Facebook profiles, and Facebook groups (irrespective of privacy settings). The AHPRA social media policy applies to all registered health practitioners (including psychologists) and provisionally registered psychologists in accredited postgraduate courses and workplace internships.
A key issue for psychologists using social media for both professional and personal purposes is managing possible boundary violations. A psychologist may decide to find out more about a client by doing a client Internet search. However, it is essential that any such search is conducted with the client’s best interests as the primary motivation, rather than the curiosity of the psychologist (APS, 2011). We suggest if a psychologist thinks this is a clinical necessity, that he or she documents occurrences in the client record, providing clear client-centred justifications for conducting the Internet search.
The culture of sharing on social media creates a sense of intimacy with others, standing in contrast to the general attitudes towards confidentiality, boundaries and self-disclosure in the psychology profession. The boundaries of ‘appropriate’ online behaviour for psychologists in terms of their personal social media engagement can be unclear, thus a cautious and considered approach is recommended (see boxed information for more details).
| Professional ‘safety’ in social media |
- Prospective and current clients, employers, supervisors, academic teaching staff and professional peers may conduct Internet searches of your name, either through search engines (e.g., Google) or within social media platforms (e.g., Facebook). Regardless of whether you use social media, conduct regular online searches of your name to be aware of the information that is available. If information is inconsistent with your responsibilities as a psychologist, take measures to have it removed (if possible).
- Maintain an appropriate ‘digital footprint’ by being mindful of information you place online and review previous postings. Avoid ‘venting’, weighing into contentious issues in public forums, or discussing work-related topics on social media.
- Increasingly, professionals are creating a professional online identity using sites such as LinkedIn and Twitter. If using these sites, you should accurately represent your skills and experience, being mindful of not using any protected titles in the profession unless relevant (e.g., educational and developmental psychologist).
- Familiarise yourself with privacy settings of your social media sites (including personal profiles under a pseudonym, and online dating profiles). Review your settings regularly as privacy policies and functionality change frequently.
- If a client requests to be your ‘friend’ on social media, discuss this with the client and reinforce the need to keep a boundary between the professional and personal (APS, 2011). Some psychologists are incorporating social media policies into their professional practice documents for clients to address these issues (Dr. Kolmes has an example policy http://drkkolmes.com/for-clinicians/social-media-policy/ ).
- Psychologists commonly interact with other AHPRA registered professionals on social media. This could lead you to become aware of information (e.g., impairment or workplace intoxication) that may require you to make a mandatory notification. Hence, psychologists should consider this when adding colleagues to their personal online networks.
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Conclusion
Despite raising professional and ethical issues relating to the use of technology and social media in psychology, there is no suggestion that these tools should not be embraced. Psychologists can extend and develop their services through competent understanding and use of these technologies. However, without due knowledge and consideration, use of these tools may increase the potential for ethical breaches and client harm. Technological issues should be integrated into the informed consent process with clients before any type of technology use occurs. Further education in these technologies and guidance in applying the existing frameworks is needed to maximise ethical and competent psychological practice in the online age.
The first author can be contacted at [email protected]