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Review Standard 3: Human Relations in the APA’s Ethical Principles of Psychologists and Code of Conduct. See Asay and Lal (2014) “Who’s Googled Whom? Trainees’ Internet and Online Social Networking Experiences, Behaviors, and Attitudes with Clients and Supervisors,” Harris and Robinson Kurpius (2014) “Social Networking and Professional Ethics: Client Searches, Informed Consent, and Disclosure,” and Taylor, McMinn, Bufford, and Chang (2010) “Psychologists’ Attitudes and Ethical Concerns Regarding the Use of Social Networking Web Sites” articles attached.(1)Examine ethical issues encountered by clinical and counseling psychologists in the digital age(2)Begin by reviewing the case of Dr. Washington attached and assume the role of a colleague to the doctor named and analyze the ethical issues encountered in the case(3)Given the situation described in the case study, recommend how your colleague should proceed(4)Provide support for your response by citing the required articles attached for this discussion(5)Consider the current and potential actions of your colleague and explain whether or not he or she is currently, or potentially will be, in violation of the APA’s Ethical Principles of Psychologists and Code of Conduct. Provide support for your explanation by citing Standard 3: Human Relations in the APA’s Ethical Principles of Psychologists and Code of Conduct(6)Explain how your colleague might avoid this type of ethical dilemma in the future(7)Describe what policy or policies you might put in place if you were your colleague?

Case 2 Dr. Washington is a counseling psychologist who specializes in trauma and self-harming behavior. Recently, he received a “friend request” from a former client who he provided individual therapy to six months ago. Dr. Washington opted not to accept the “friend request,” but considered sending a private message to the client with the social networking policy from his informed consent.  Dr. Washington is uncertain whether or not to send the private message to the client.

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Who’s Googled Whom? Trainees’ Internet and Online Social Networking Experiences, Behaviors, and Attitudes With Clients and Supervisors

Penelope A. Asay Illinois School of Professional Psychology

Ashwini Lal California State Polytechnic University

The ubiquity of the Internet and online social networking creates rapidly developing opportunities and challenges for psychologists and trainees in the domains of relationships, privacy, and connection. As trainees increasingly are natives of an Internet culture, questions arise about the ways in which developing psychol- ogists may view Internet issues and the guidance they receive from professional psychologists for whom the Internet is a significant cultural shift. A national survey of graduate students (n � 407) assessed student Internet behaviors (e.g., “Googling” clients, online social networking), training about online issues, attitudes toward online social networking and client or supervisor contact via these networks, and fears and comfort about making decisions regarding these networks. The survey also assessed what students reported they would do and what they would think if clients and supervisors contacted them via social networks. Results indicate that most trainees have changed and monitored their online presence since beginning graduate school. A quarter of respondents had “Googled” clients, and almost half had “Googled” supervisors. A small number indicated that both clients and supervisors had reported “Googling” the trainee. Students expressed concerns about making ethical decisions about online social networks. Half reported discussing Internet issues in their graduate training programs, whereas a quarter indicated they had discussed Internet issues at their training sites. Implications for training are discussed, with recommendations of program disclosure of Internet policies to students, discussion of Internet issues before trainee clinical work, role plays of ethical issues, and supervisor-initiated discussions of Internet issues.

Keywords: ethics, Internet, privacy, supervision, training

The social shifts occurring as a result of the rise of the Internet have naturally attracted much popular and scholarly attention. The implications for personal and professional lives, for what it means to be social, relational beings and how and what people both know and know about each other are substantial. A New York Times article (Rosen, 2010) proclaimed that the Internet means “the end of forgetting.” Traumas, triumphs, missteps, and mundane mo- ments no longer exist merely in personal pasts; rather, they may exist for all to see, for all time. In a world in which people can now be—and are expected to be— constantly connected, it may be increasingly difficult to carve out what is uniquely personal. Webb

and Widseth (2012) wrote about the “erosion of aloneness.” Pri- vate moments are captured, posted, and sometimes only en- joyed— or experienced—after public recognition and feedback. For the new generation, they wrote, “everything is instantaneous; everything is public and immediate” (Webb & Widseth, 2012, p. 165).

Relationally, the Internet and online social networking sites like Facebook are changing how people interact and how people ex- perience self and the world. Work has investigated the implications of technology and online social networking for conceptions of personal privacy, in-person and online relationships (Turkle, 2010), and even changing experiences with death (Kasket, 2012). Recent work suggests that online relationships and interactions have very real impacts on mood and mental health. These impacts can be positive, facilitating interaction and feelings of connected- ness and comfort (Alloway & Alloway, 2012; Baker & Oswald, 2012), and negative, especially in increasing instances of cyber- bullying (Sengupta & Chaudhuri, 2011; Siegel, 2012). Though some studies have shown an increase in depressive symptoms, for example, with greater use of the Internet (Kraut et al., 2002; Selfhout, Branje, Delsing, Ter Bogt, & Meeus, 2009), others have shown there to be benefits of general Internet use and online social networking (Morgan & Cotton, 2003).

Use of Internet Information

The individual responsibility of what and how people share on the Internet presents a novel realm of choice. Deciding what to post on a blog or social networking site may be momentary

This article was published Online First March 17, 2014. PENELOPE A. ASAY earned her PhD in counseling psychology from the University of Maryland. She is associate professor at the Illinois School of Professional Psychology, Argosy University, Chicago. Her research inter- ests include clinical training and existential issues in the Internet Age. ASHWINI LAL earned his PsyD from the Illinois School of Professional Psychology. He completed his APA accredited pre-doctoral internship at Northport Veterans Affairs Medical Center, Northport, New York and his post-doctoral residency at California State Polytechnic University, Pomona, California. His interests include mood and anxiety disorders, loss, transitions, and health-behavior related changes. He is currently a contrib- uting author to the website Psychology In Everyday Life. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Penel- ope A. Asay, Associate Professor, Illinois School of Professional Psychol- ogy, Argosy University, Chicago, 225 N. Michigan Avenue, Chicago, IL 60601. E-mail: [email protected]

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Training and Education in Professional Psychology © 2014 American Psychological Association 2014, Vol. 8, No. 2, 105–111 1931-3918/14/$12.00 DOI: 10.1037/tep0000035

105

decisions with long-term consequences. Employers conduct Inter- net searches of potential and current employees. Patients seek out information before meeting physicians and psychotherapists. In- deed, Gibbs, Ellison, and Lai (2011) regarded “Googling” (e.g., conducting online searches) those encountered in online dating activities as one example of an “uncertainty reduction strategy” (p. 72).

A survey by the Society for Human Resource Management in 2011 reported that 26% of organizations were using search engines and 18% of organizations were using social networking sites to screen job candidates (Society for Human Resource Management, 2011). Results also may have suggested a trend involving a change from “Googling” potential employees to searching online social networking sites. An article in the New England Journal of Med- icine (Gorrindo & Groves, 2008) emphasized various issues sur- rounding the use of the Internet and the ease with which physician information can be obtained. These authors discussed and explored the problems associated with the information the Internet has made available to patients and described methods by which a physician can protect him or herself. The various methods of self-protection included increasing privacy settings on social networking sites, removing slanderous information, talking with patients about how they use the Internet, and creating a professional Web page that allows for specific content to be posted.

At the same time, opportunities for utilizing the Internet for professional practice have blossomed. The APA Practice Direc- torate (2009) advised, “Since you don’t know by which online channel someone will find your practice, connecting all the places where you appear on the Web is important” (p. 8). Psychologist Keely Kolmes developed a Private Practice Social Media Policy that she shares on her Web site (Kolmes, 2013). The policy addresses specifically the issues of “Friending,” “Use of Search Engines,” “Following” (Twitter, blogs), and the almost quaint by comparison “E-mail.” It has rapidly become common practice for clients/patients to conduct Internet searches for health information (Fox, 2011; Lehavot, 2009; Zur, Williams, Lehavot, Knapp, 2009). In light of the new “consumer” mentality, Gottleib (2012) sug- gested that Internet presence is essential for professional practice and psychotherapists should consider how to utilize Web sites, blogs, and social networking to “brand” themselves.

Privacy

Kaslow, Patterson, and Gottlieb (2011) asserted that although people know nothing on the Internet is private, “many people willingly post personal information based on a mistaken assump- tion of privacy” (p. 3). Yet, the very concept of privacy is shifting, authors argued, for new generations. This “new privacy” is “about controlling how many people know-not if anyone knows” (Melber, 2008, p. 22). As the concept of privacy in psychotherapy is integral to its practice and addressed in the Ethical Principles of Psychol- ogists and Code of Conduct (American Psychological Association, 2002), refining or redefining “privacy” is no small feat.

Realistically, individuals can only control so much of what is kept private. Once on the Internet, it is usually impossible to remove information, true or false. Being a deeply relational en- deavor involving (almost exclusively one-way) personal informa- tion disclosure, psychotherapy is particularly impacted by these rapid changes in knowledge acquisition. Psychotherapy literature

emphasizes the establishment of trust and the importance and meaningfulness of timing and intention in disclosure. Yet, with information available to both client and psychotherapist outside of psychotherapy, such dimensions are less controllable. Curious clients (and psychotherapists) can find information about political contributions, home purchases, and whereabouts (Gabbard, Kas- saw, & Perez-Garcia, 2011). Taylor, McMinn, Bufford, and Chang (2010) referred to this as the “demise of intentionality,” and suggested, “full intentionality is a thing of the past” (p. 157). Psychotherapists (and clients) can also unintentionally find infor- mation online or inadvertently have online interaction (e.g., Face- book suggestions for “People You May Know”). The relational and ethical implications for seeking out online information, inad- vertently finding information, and requesting contact via social networking are quite different. Considerations of intention, impact, and self-disclosure are crucial factors in deciding what a psycho- therapist does with this information.

Ethics

Much of the literature has explored concerns about ethical issues, training, and clinical implications of “e-professionalism” (Barnett & Russo, 2009; DiLillo & Gale, 2011; Kaslow et al., 2011; Lehavot, 2009; Lehavot, Barnett, & Powers, 2010; Merdian, 2012). A few empirical studies have investigated both graduate students’ and psychologists’ online experience and attitudes (DiL- illo & Gale, 2011; Lehavot et al., 2010; Tunick, Mednick & Conroy, 2011). In general, results indicated that psychologists and trainees are experiencing these online interactions with some reg- ularity. In a sample of child psychologists and trainees, 32% reported reading blogs and social networking sites of their clients for a variety of reasons, including curiosity and concern (Tunick, Mednick & Conroy, 2011). “Googling” clients is not uncommon, with 32% of that sample reporting doing so, 27% of a sample of graduate students (Lehavot et al., 2010), and almost the entirety of a sample of psychology doctoral students (97.8%), despite the majority of these believing it was unacceptable to do so (DiLillo & Gale, 2011). Yet, in a sample of graduate students and psycholo- gists, participants reported almost never discussing aspects of online behavior with clients (Taylor et al., 2010). These issues clearly exist in psychotherapy and raise concerns and questions that evolve more rapidly than the answers.

Training and Supervision

Students are being trained in the midst of these rapidly evolving technologies and emerging issues. A real gap in the literature appears to be attention to the critical realm of super- vision. The supervisory relationship is integral not only to providing effective service to clients, but also to developing the trainee’s competence and professionalism. The ways in which supervisors model behavior in the realm of e-professionalism and their ability to discuss these issues with trainees are important. Information seeking on the part of supervisors may be a part of hiring, of monitoring professional development, or of simple cu- riosity. Supervisors, of course, are just as susceptible to being “Googled” by their supervisees and of having the “small world” problems that supervisees may have with their clients. Similar implications arise in terms of what is known by whom, how, and

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106 ASAY AND LAL

how (or whether) that knowledge is shared in the supervisory relationship.

Just as between trainee and client, cohort differences may be important between supervisee and supervisor. Supervisors may be less knowledgeable than trainees about constantly changing Inter- net issues, making professional guidance in this realm difficult (Kolmes, 2012). Prensky (2001) identified “digital immigrants,” those who have seen the development of the Internet in their lifetimes, and “digital natives,” the cohort of people who have grown up with the Internet. In a survey of practicing psychologists and graduate students, not one participant over the age of 54 reported having social networking site profile (Taylor et al., 2010). Other work appears to refute this finding (Hogeboom, McDermott, Perrin, Osman, Bell-Ellison, 2010; Wayne, 2010). At the same time, supervisors may have more expertise and sophisticated ways of thinking about implications of Internet issues in therapy. Still, with technology emerging rapidly, it is likely that “digital natives” have a new cultural experience.

Internet Issues as Cultural Competence

As literature has discussed the new Internet culture (Schirm- acher, 2007), with its “inhabitants” described as “digital natives” (Prensky, 2001), “Gen-i”(for “Generation i”) (Yip, 2010) who are “bilingual” in verbal and digital communication (Lehavot, Barnett, & Powers, 2010), it may be helpful to frame dealing with issues of the Internet as a new realm of cultural competence. As with trainees who are more multiculturally competent than their super- visors, trainees who are more Internet savvy may feel at a loss. Trainees may be actively or passively discouraged from addressing Internet issues in supervision, or they may find supervisor re- sponses unhelpful or minimizing (Ancis & Ladany, 2001; Burkard et al., 2006). Authors have suggested this “generation gap” should not preclude rich discussions and encourage supervisors to educate themselves via the literature and their trainees (Myers, Endres, Ruddy, & Zalikovsky, 2012). Graduate programs have also been encouraged to create and communicate clear Internet boundaries and policies (Kaslow et al., 2011; Kolmes, 2012; Myers et al., 2012).

Thus, the current study was designed to investigate graduate student trainees’ experiences with, comfort with, and concerns about Internet issues in their training. The study assessed not only trainees’ own behaviors, but also their knowledge of behaviors and feelings about the behaviors of their clients and their supervisors. Because there is no current literature addressing the prevalence of these behaviors in supervision, the authors thought this dimension crucial to add to the discussion. The study also assessed what trainees reported they would do, think, and feel in reaction to social networking contact by both clients and supervisors.

Method

Participants

A total of 407 participants completed the survey. The respon- dents were 80.6% white, 5.7% African American/black, 3.8% Asian, 4.6% Hispanic, and 5.2% other. Participants identified themselves as 84.4% female, 15.3% male, and 0.3% other. Most participants were attending a clinical psychology program

(86.6%), 12% were attending a counseling psychology program, and 1.4% indicated other. Of the participants, 6.5% were enrolled in an M.A. program, 27.8% were enrolled in a Ph.D. program, and 67.6% were enrolled in a Psy.D. program. Participants identified as humanistic/existential (14%), psychodynamic/analytic (30.8%), client-centered (23.8%), cognitive-behavioral (50.1%), feminist/ multicultural (8.7%), and other (15.7%). Participants’ training sites included counseling center (39%), hospital (43%), community health center (59.9%), middle/high school (18%), VA hospital (6.7%), and other (36.9%).

Procedure

After obtaining IRB approval, data were collected in two waves: in the first wave, the primary investigator sent an e-mail invitation to contacts in Clinical Psychology PsyD programs at several campuses of a national university. In the second wave, the primary investigator sent an e-mail invitation to contacts listed on the APA Web site for all APA-accredited doctoral programs in counseling, clinical, and combined psychology. In both waves, contacts were asked to distribute the invitation to students in their doctoral program. Participants clicked on a link that took them to an informed consent page. Upon clicking “Next,” they went to the survey.

Measure

The researchers created a survey instrument for the purposes of exploring online social networking habits, experiences, and con- cerns. The survey consisted of yes/no and Likert-scale questions in addition to having blank space for any additional comments from participants. The survey included questions about habits and atti- tudes, ethical concerns, and level of comfort. The survey included questions regarding thoughts about and experiences with clients and with supervisors. A scale that was created to assess trainees’ professional self-disclosure attitudes and behaviors did not have adequate internal consistency, and was thus dropped from analysis.

Results

Personal and Training Behavior Prevalence

Of the 407 participants, 93% (378) indicated they have a social networking account. Most thought social networking accounts were a good way to stay in touch with friends (88.4%), and only 6.9% reported they were a waste of time (these two responses were not mutually exclusive). Since starting graduate school, 74% in- dicated they had changed the content of their social networking accounts: 89.7% changed privacy settings, 61.1% modified pic- tures, and 56.8% changed personal information. Since starting graduate school, 74% of participants reported “Googling” them- selves. Two thirds (64.4%) indicated they had discussed Internet issues in their graduate programs. Most often, these discussions were in ethics classes (51.5%), followed by professional orienta- tion classes (44.6%), special discussions (24.8%), and other (25.6%). In contrast, only a fourth of students (25.6%) indicated they had discussed these issues at training sites.

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107WHO’S “GOOGLED” WHOM?

Professional Behavior Prevalence

Responses suggest that, overall, most trainees are neither seek- ing out information or contact nor are they aware of being the subject of searches or online contact (see Table 1). Still, more than a fourth (25.6%) indicated they had “Googled” clients, almost half (44.6%) indicated they had “Googled” supervisors, and almost two thirds (63.7%) had “Googled” other professional colleagues. Some reported that clients had disclosed to them that they had “Googled” the trainee (11.4%), whereas almost none indicated their supervi- sors had (2.7%). As for social networking sites, 6.5% indicated clients had contacted them via these sites, 8.5% indicated super- visors had contacted them, and 56.2% indicated other colleagues contacted them. In psychotherapy, the majority (74.1%) of partic- ipants indicated they had not discussed social networking at all with clients. Of those who had, the client brought up the issue the majority of the time (61.6%).

Concerns and Comfort

In terms of ethical concerns, 72.5% of respondents indicated they were either “concerned” or “very concerned” about the ethical implications of contacting their clients on social networking sites. Forty-three percent indicated concern about the ethical implica- tions of contacting their supervisors while engaged in a supervi- sory relationship; however, once the relationship had concluded, only 21% indicated concern.

In terms of comfort, 90.8% of respondents reported they would be “uncomfortable” or “very uncomfortable” if their clients con- tacted them via social networking while they were engaged in psychotherapy. Similarly, 87.1% reported discomfort with contact after the psychotherapy had concluded. If a supervisor contacted them while in an ongoing supervisory relationship, 58.1% indi- cated they would be “uncomfortable” or “very uncomfortable.” Once the relationship had concluded, only 30.5% anticipated dis- comfort with a supervisor’s contact.

More than half (54.5%) indicated they would be concerned about making an ethical decision about contact via their social networking account, and fewer than half (40.3%) indicated they would feel comfortable making an ethical decision about such contact. Tables 2 and 3 indicate what students would do and think if clients and supervisors contacted them. It seems notable that whereas almost all (96.3%) report they would discuss social net- work account contact with clients, fewer (72.1%) would bring up the issue with their supervisors. Interestingly, a minority indicated

they viewed such contact as an invasion of privacy (24.1% for client contact; 17.4% for supervisor contact).

Discussion

The current study suggests that most trainees seem aware and concerned about their own personal and professional Internet presence. They reported monitoring their Internet presence since beginning graduate training and modifying their social networking site(s). These behaviors suggest that graduate students are aware that their Internet presence is relevant to their training and profes- sional development, as the literature recommended (Barnett & Russo, 2009), and as previous findings have suggested (Taylor et al., 2010). Respondents also reported attention to these issues in about two thirds of their graduate programs, but only a quarter of their training sites. They are concerned about their ability to make an ethical decision involving social networking contact, and fewer than half were comfortable about making such a decision. Such concerns seem to be increasingly likely to be realized: 11.4% reported they have had clients tell them they had “Googled” the trainee, slightly higher than findings in previous studies (7%; Lehavot et al., 2010). Perhaps these results suggest students are aware of some lack of guidance and training in this area and reflect an appropriate response to a developing professional issue. Nota- bly, trainees distinguish that during or after psychotherapy, online social networking contact from clients is uncomfortable, whereas they are more comfortable with supervisor contact, especially after the conclusion of the relationship.

The current study supports previous findings about “Googling” clients: a fourth of the current sample reported having done so. This is a similar number to findings by Lehavot et al. (2010), who

Table 2 Hypothetical Responses to Client Contact via Online Social Networking Site

I would . . . Percent %

Discuss it with my client 96.3 Tell my supervisor 94.5 Tell other professional colleagues 30.2 Consider it an invasion of my privacy 24.1 Consider it a sign of some client psychopathology 6.6 Consider it a sign of the strength of the relationship 5.8 Not think too much of it at all 2.1

Table 1 Professional Behavior Prevalence

Statements Yes (%)

I have had other professional colleagues contact me via my social networking account 56.2 I have discussed social networking accounts with my clients 25.9 I have had my supervisors contact me via my social networking account 8.5 I have had clients contact me via my social networking account 6.5 I have searched the Internet for other professional colleagues 63.7 I have searched the Internet for my supervisor 44.5 I have searched the Internet for my clients 25.6 Other professional colleagues have told me they searched the Internet for me 24.1 My clients have told me they searched the Internet for me 11.4 My supervisor has told me he/she searched the Internet for me 2.7

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108 ASAY AND LAL

reported 27% of graduate students had “Googled” clients. Inter- estingly, a recent study by DiLillo and Gale (2011) reported that almost their entire sample of graduate students (97.8%) reported searching for at least one client’s information in the past year. At the same time, their sample reported clients were aware of over- whelming majority of these searches (Internet: 82.1%; social net- working site: 82.5%), although it is unclear whether this was a priori or after the fact. The current study (and previous studies) did not ascertain the client’s knowledge about these searches, and this discrepancy does raise interesting questions. Possibly, such searches are rapidly becoming a more common occurrence within the psychotherapy hour, or at the request of the client, especially with minors (Tunick, Mednick, & Conroy, 2011). In any case, more detail about how such searches are conducted is warranted, especially when they are at the express request or in collaboration with the client. Internet searches can be used and used well therapeutically. Clinton, Silverman, and Brendel (2010) addressed this very notion. They proposed a model of “patient-targeted Googling” that considered the “intention of searching, the antici- pated effect of gaining information online, and its potential value and risk for treatment” (p. 105). Their model addressed 6 ques- tions: reason for conducting the search, search benefit or harm to the treatment, addressing whether informed consent should be obtained, determining whether to share the results with the patient, deciding whether to document the findings in the patient’s record, and continually monitoring one’s own motivations for and the risks versus benefits of searching. Discussion of the impact of such a practice on the therapeutic relationship in psychotherapy practice warrants continued attention.

The current study appears to be the first to ask trainees what they would do and think in response to hypothetical client and supervisor contact via social networking sites. Interestingly, most would not see such contacts as an invasion of privacy by client or supervisor, although they would still feel uncomfortable about such contacts. Despite deep concerns being raised about privacy (Kaslow et al., 2011; Lehavot, 2009a; Lehavot, 2009b; Lehavot et al., 2010;), perhaps, as Melber (2008) suggested, people’s notion of privacy is evolving with the Internet. Indeed, as trainees and clients are increasingly “digital natives,” such notions may change even more. Respondents in the current study may consider social network sites as a risk worth managing and contact via these sites from clients and supervisors as inevitable (or at least unsurprising). Interesting questions arise about the applicability of the Ethics Code principles on privacy when the very notion of what is private for supervisors, trainees, and clients may be very different. In the current study, one respondent commented,

It would be difficult to tell a supervisor I did not want to add them (to a social networking site) because I do n