Setting Boundaries When Working with ClientsPrior to beginning work on this week’s discussion, please review Standard 3: Human Relations (Links to an external site.)Links to an external site. in the

Social Networking and Professional Ethics:

Client Searches, Informed Consent, and Disclosure Sara E. HarrisMarquette University Sharon E. Robinson Kurpius Arizona State University As mental health professionals are increasingly using technology in their clinical work, it is important that research examines the ethical implications of online behaviors. This study examined the online behaviors of 315 counseling and psychology graduate students. Hierarchical multiple regression was used to examine online client searches, informed consent, and disclosures. Increased disclosure of client information was related to lower scores on ethical decision-making and to program type (counseling, clinical, or school). Ethical decision-making moderated online disclosure for participants in school psychology programs. Of those with supervised clinical experience, a third had used the Internet to find information about a client. Progress in the participants’ academic program, as measured by academic credits, and years of social networking experience were positively related to increased online client searches. The majority who conducted an online search did not obtain client informed consent before conducting the search. Reported therapeutic concern about client welfare and gathering information for intervention were significant predictors of obtaining informed consent.

Keywords:social networking, disclosure, informed consent, online client search Social networking sites, such as Facebook, Twitter, Google , Myspace, Classmates.com, Linkedin, and LiveJour- nal, provide a new medium for people to meet, reconnect, find others with similar interests, network with professionals, share information, and even find love. Social networking is increas- ingly interwoven into today’s social and business world. When one peruses social networking sites, universities, Fortune 500 companies, advocacy groups, and even churches can be found.

Facebook has more than 500 million active users, half of whom access their account daily (Statistics, Facebook.com, 2010). To track the growth of social networking use in the United States, the Pew Research Center has collected yearly data since 2005.

The most recent data on more than 2000 individuals over the age of 18 revealed that the percent of adults who participated insocial networking rose from 61% in 2010 to 65% in 2011, with 43% accessing their account daily (Madden & Zickuhr, 2011).

The majority of users are females between the ages of 18 and 29. Although membership for the 18- to 29-year-olds has re- mained relatively steady, between 83% and 86%, it is increas- ing for older individuals (Madden & Zickuhr, 2011). For ex- ample, online membership rose from 61% in 2010 to 70% in 2011 for 50 to 64-year-olds and from 26% to 33% for those older than 65. That online membership is becoming a cultural norm rather than an exception underscores the importance of research related to this new medium.

Mental health professionals are no exception to the trend of social networking use. Studying student members of Divisions 29 (Psychotherapy) and 42 (Psychologists in Independent Prac- tice) of the American Psychological Association (APA),Le- havot, Barnett, and Powers (2010)found that 81% had a social networking site. Focusing on counseling, clinical, and school psychology graduate students,DiLillo and Gale (2011)reported that 71.8% of the 854 students had a social networking site.

Another study of 695 mental health students and professionals found that 77% reported maintaining a social networking page (Taylor, McMinn, Bufford, & Chang, 2010). Of the 528 who were under the age of 30, 85% participated in social network- ing; however, no one over the age of 54 did. A survey of APA Council of Representatives and division presidents conducted byMcMinn, Hathaway, Woods, and Snow (2009)also revealed that no one over the age of 54 maintained a social networking site. It is evident that younger mental health professionals are the active members of social networking sites. Additionally, social networking is relatively new and may not be an area in which students and new professionals can turn to their super- visors or university faculty for advice.

SARA E. H ARRIS is currently pursuing a PhD in Counseling Psychology at Marquette University and also spends her time as a researcher at the Penfield Children’s Center Behavior Clinic. Her research and professional interests include children’s reactions to traumatic stress, development and validation of pediatric psychological tests, and professional ethics.

S HARON E. R OBINSON KURPIUS is a professor and Director of Clinical Training for the Counseling and Counseling Psychology programs at Arizona State University. She holds fellow status in the American Educa- tional Research Association and three divisions of the American Psycho- logical Association (APA)–Counseling Psychology, Consulting Psychol- ogy, and Health Psychology. Her research interests include women and health, intimate relationships, ethics and values, academic persistence, and aging.

C ORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Sara E.

Harris, Marquette University, Department of Counselor Education and Counseling Psychology, College of Education, Schroeder Complex, P. O.

Box 1881, Milwaukee WI 53201-1881. E-mail:[email protected] This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Professional Psychology: Research and Practice© 2014 American Psychological Association 2014, Vol. 45, No. 1, 11–190735-7028/14/$12.00 DOI:10.1037/a0033478 11 Although the APA Ethical Principles (2010) does not specifi- cally address standards for social networking sites, it does assert that the “application of an Ethical Standard may vary depending on the context” (p. 1) and that “The fact that a given conduct is not specifically addressed by an Ethical Standard does not mean that it is necessarily either ethical or unethical” (p. 1).Taylor et al. (2010) found a slight negative correlation between age and favoring APA involvement in providing set standards, with younger participants more likely to favor APA involvement.

Any hesitancy, however, related to developing ethical guide- lines for social networking may be coming to an end. APA ethics director Stephen Behnke stated “with a very high degree of con- fidence that when APA does draft the next code, the drafters will be very mindful of many issues being raised by social media” (Martin, 2010, p. 32). The widespread use of social networking is also cited as a catalyst for revision of the American Counseling Association (ACA, 2005) Code of Ethics (Rollins, 2011). The concern of the APA and ACA highlights the need to study pro- fessional behaviors related to social networking, particularly be- haviors that might be unethical.

Social networking creates many complex ethical dilemmas, particularly those related to privacy, confidentiality, and informed consent, which often do not have clear-cut answers. It is critical that psychologists and counselors have an understanding of ethical concepts and subsequent boundaries and transfer this understand- ing to their professional online behaviors.

Privacy refers to the clients’ right to decide how much of their behaviors, thoughts, and feelings they share with others (Koocher & Keith-Spiegel, 2008).APA (2010)Principle E states, psychol- ogists should “respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self- determination.” Mental health professionals respect the client’s choice to disclose information and do not engage in activities that bias their work. For example, learning about a facet of the client’s identity through a social networking site without processing this new information with the client could introduce bias into the therapeutic relationship, compromise the client’s fundamental right to privacy, and place the counselor in a position of knowing something the client has not directly shared.

Some have argued that certain instances may warrant examina- tion of a client’s social networking page (DiLillo & Gale, 2011; Martin, 2010). For example, viewing a social networking page of a suicidal client who has missed recent sessions may provide some insight into the client’s whereabouts and state of mind. Information obtained, however, could be inaccurate or be out of context. For example, if a client was being treated for severe alcohol depen- dence, pictures of him/her “partying” could cause the therapist to be alarmed. The clinician’s interpretation could change drastically if it was revealed that the pictures were taken years ago.Behnke (2008)warned that, “There is a “slippery slope” to seeking and relying on such information that risks turning psychologists into private investigators” (p. 75).

Despite ethical guidelines, confidentiality creates some of the most challenging and confusing ethical dilemmas (Koocher & Keith-Spiegel, 2008). Social networking adds a unique layer to the already complex construct; the public or private nature of infor- mation posted online is ambiguous. TheAPA (2010)Ethical Principles state “Psychologists have a primary obligation and take reasonable precautions to protect confidential information ob-tained through or stored in any medium” (p. 7). It could be argued that social networking is a new medium through which mental health professionals can obtain information and that the standards for confidentiality still apply.

The importance of clients being informed consumers of thera- peutic services is captured in the ethical standards involving in- formed consent. TheAPA (2010)emphasizes that informed con- sent should be readdressed as new circumstances warrant.

Somberg, Stone, and Claiborn (1993)examined a variety of con- texts in which informed consent should be obtained (e.g., limits of confidentiality, potential risks of therapy) and reasons for not obtaining this consent. Some of the most common reasons in- cluded the belief that the issue was not relevant or necessary and that the risk of not obtaining consent was perceived as being low or none. This highlights the role of the clinician’s own personal attribution of importance plays in the informed consent process.

The reason for online searches (e.g., verification of information, treatment planning), therefore, may predict whether the clinician obtains informed consent.

Despite ethical risks, between 27% and 97.8% of student psychotherapists report seeking client information through the Internet (DiLillo & Gale, 2011;Lehavot et al., 2010). Factors that predict these searches are unclear. A positive correlation between trainee year in program and acceptability of searching for client information using a search engine was noted in one study (DiLillo & Gale, 2011). Explanations of this finding were not provided by the researchers. Could the finding be the result of the passage of time or the result of a third variable such as increased exposure to clients? Another factor that likely con- tributes to online client searches is years of social networking experience. Individuals who have been members of social net- working sites for many years may be more familiar with how to navigate these websites and feel more comfortable conducting a search through this medium.

Few studies have examined online disclosures, particularly disclosures related to clients.Frye and Dornish (2010)found that experience with social networking communication tools was related to increased comfort in self-disclosing, regardless of the perceived level of privacy, and speculated that the link between privacy concerns and online disclosure may be attrib- uted to individuals’ perceived level of knowledge surrounding privacy settings and the belief that others would be unlikely to intercept the communication. In contrast,Zur, Williams, Le- havot, and Knapp (2009)argued that young professionals have grown up with the Internet and personal disclosures on this medium have become ingrained as a part of life. They warned that students might need support in examining their disclosures from a clinical perspective. Instruction on ethical standards may vary by program type (school, counseling, clinical) and by individual institution. For example, some programs require a formal ethics class while others have ethics embedded into their coursework and practicum classes. Interest and expertise in ethics, as reflected by major areas of research interest also varies by program, with 18% of counseling psychology pro- grams and 6% of clinical psychology programs citing profes- sional ethics as a focal area (Norcross, Sayette, Mayne, Karg, & Turkson, 1998).Pope and Vetter (1992)studied a random sample of current APA members and found that confidentiality was the most frequently encountered ethical dilemma (18%). This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 12 HARRIS AND ROBINSON KURPIUS Similarly,Dailor and Jacobs (2011)conducted a survey of practitioner members of the National Association of School Psychologists and found that 33% had witnessed an ethical transgression regarding confidentiality. This suggests that is- sues surrounding confidentiality may pose additional compli- cations for school psychologists compared with those in coun- seling or clinical psychology programs. This may be attributed to the complexities of disclosure (e.g., balancing student con- fidentiality with parental rights) within a school setting. Issues surrounding confidentiality and disclosure are also cited as the most common and challenging ethical concerns among coun- selors in a school setting (Bodenhorn, 2006). Although these behaviors are observed in person, they may also transfer to the online environment. It is important to note that individuals who share information about their clients (overtly or covertly) online may also be at greater risk of violating other professional boundaries. However, individuals with better ethical decision- making may be less likely to engage in unethical behaviors despite program affiliation/training.

Although sharing personally identifying information about a client without the client’s consent is a clear violation ofAPA (2010)Ethical Principles, other disclosures may not be as clear-cut. For example, would it be acceptable to casually express displeasure online by stating that an unnamed client missed an appointment? Issues surrounding disclosures have already caused lawsuits in the field of medicine. A recent court case, Doe v. Green, involved a paramedic who disclosed details on a social networking site that he thought did not overtly identify (e.g., name) the victim of a rape (Clark, 2010). Al- though Green’s intentions may have been to warn other poten- tial victims, he provided information on his Web site that the survivor thought was identifiable and that resulted in a lawsuit.

Such risk exists for all professionals who have an ethical and legal obligation surrounding client confidentiality. It is impor- tant to increase awareness of the possible damage that can be caused by a metaphorical slip of the finger. Even with adequate consent,Koocher and Keith-Spiegel (2008)recommended that professional caution be used before sharing any information through a news outlet and identified “inadequate anticipation” of consequences as one of the “risky conditions” that can lead to ethical dilemmas (p. 16). Thus, it is important that potential ethical dilemmas related to social networking sites are ad- dressed in graduate training and current professional behaviors and beliefs surrounding social networking participation are explored.

The current study examined the online practices of counsel- ing and psychology graduate students and generated hierarchi- cal regression models for online client searches, best practices in informed consent, and disclosure. Two specific hypotheses were addressed: (1) Lower scores on ethical decision-making, greater experience with social networking, more perceived knowledge of privacy settings, enrollment in a school psychol- ogy or school counseling program, and the interaction of ethical decision making and program type will be related to more disclosure of client information on social networking; and (2) Credits, direct client hours, and years of social networking experience will be positively related to online searches of client information. Additionally, one exploratory analysis was con-ducted to examine whether reason for online search would predict obtaining informed consent. Method Participants and Procedures After Institutional Review Board approval was obtained, grad- uate students in counseling and in psychology programs were recruited by sending emails to liaisons of Council of Counseling and Related Educational Programs (CACREP) programs and to Directors of Clinical Training (DCT) for psychology programs.

Interested students were directed to the Survey Gizmo Web site where they gave consent to participate before completing the survey. Approximately 77.5% of those who opened the survey completed it. As incentive for completing the questionnaire, par- ticipants were offered the opportunity to win one of four $20 Visa gift cards. G Analyses indicated that a sample size of at least 85 was needed to achieve statistical significance with an alpha of .05, a power level of .80, and a .15 effect size.

The 315 graduate students (264 females; 49 males; 2 not iden- tified) who completed the survey resided in 35 states and had an average age of 28.4 years (SD 6.21). Most identified as Cau- casian/Euro American (n 248; 78.5%), with 20 (6.3%) identi- fying as Asian/Pacific Islander, 17 (5.4%) as Black/African Amer- ican, 18 (5.7%) as Hispanic/Latino/a, 2 (.6%) as Native American/ Alaska Native, and 11 (3.4.%) as Other/Multi-Racial. Over half (57.4%) were enrolled in a doctoral program. Programs surveyed included counseling (n 95; 30.2%), counseling psychology (n 76; 24.1%), clinical psychology masters programs (n 11; 3.5%), school counseling (n 28; 8.9%), school psychology (n 59; 18.7%), and clinical psychology doctoral programs (n 46; 14.6%).

Only 19 (6%) did not belong to a social networking site. Of the 297 who did, 292 (98.6%) had social networking pages on Face- book, 96 (32.8%) on LinkedIn, 91 (30.6%) on YouTube, 87 (29.3%) on Google , 76 (25.5%) on Twitter, 25 (8.4%) on My- space, 20 (6.7%) on Yelp, and 32 (10.8%) on other social net- working sites. On average, students had 2.43 (SD 1.5) social network memberships and had maintained their networking page for 5.8 years (SD 2.0). More than two thirds (79.7%) accessed at least one of their accounts daily, although the vast majority (92.9%) had accessed at least one of their accounts by the end of the week. Measures Multiple outcome variables were assessed. These included on- line client searches, informed consent, online disclosures, ethical decision making, and privacy knowledge.

Online client searches.Frequency of online client searches was measured by two items: “I have conducted a Google Search to find out or verify information about my client” and “I have conducted a social networking search to find out or verify information about my client.” Each item was responded to on a 6-point Likert-type scale, with anchors ranging fromNever(1) toVery Frequently(6). Responses were summed to form a total score that could range from 2 to 12, with higher scores indi- cating greater frequency of client online searches. For the study This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 13 SOCIAL NETWORKING AND PROFESSIONAL ETHICS sample, the coefficient alpha was .73 and scale mean was 2.86 (SD 1.57).

Informed consent.Five items, derived from theAPA (2010) and ACA (2005) ethical standards to assess best practices in informed consent and identified bySomberg et al. (1993)as important elements of informed consent (i.e., limits of confiden- tiality, potential risks of therapy, length of treatment, possible procedures used, and alternatives to therapy), were used to mea- sure Informed Consent. Each item was rated on a scale from 1 (Never)to6(Very Frequently). Sample items include the follow- ing: “I obtained informed consent from my clients before conduct- ing an online search (e.g., Social networking, Google)” and “I discussed with my client the benefits and drawbacks of conducting an online search about them.” Responses were summed to form a total score, with higher scores indicating more use of informed consent practices. Total scores could range from 5 to 30. For the current sample, the scale mean was 7.25 (SD 5.33), and the coefficient alpha was .93.

Online disclosures.The extent to which participants dis- closed client information online was assessed by eight items rated on a 6-point Likert-type scale (1 Neverto 6 Very Frequently).

Sample items include the following: “I have expressed positive thoughts/feelings (e.g., happiness, optimism, hopefulness, etc.) online about a client but did not provide information that I believe could readily identify the client”; “I have posted an update online that indirectly referenced negative thoughts/feelings (e.g., disap- pointment, frustration, sadness, etc.) I was having about a client”; and “I would warn my online friends about a client who is dangerous.” Total scores, which could range from 8 to 48, were calculated by summing responses across the items.

Higher scores reflect more disclosure. For the current sample, the scale mean was 9.81 (SD 3.68), and the coefficient alpha was .84.

Ethical decision-making.The ethical decision-making sub- scale ofKendall et al. (2011)Boundaries in Practice measure, which includes 10 scenarios to assess ethical decision-making, was used. A sample scenario was “You have been under a lot of personal stress and the client asks you what is wrong. You find yourself telling the client about your problems.” For each scenario the participant was asked, “How ethical is this decision?” Deci- sions were rated on a 4-point Likert-type scale, with anchors ranging fromNever Ethical(4) toAlways Ethical(1). In addition, another item, “You begin therapy with a client and you find that you are attracted to each other” was presented for the sexual attraction scenario. This resulted in an 11-item scale with re- sponses summed across items. Scores could range from 11 to 44.

Higher total scores reflect belief that scenarios were not ethical and indicate good-decision making.Kendall et al. (2011)established content and face validity through use of expert panel ratings. They reported a coefficient alpha of .86. For the current study, the coefficient alpha was .75, and the scale mean was 38.87 (SD 2.99).

Privacy knowledge.Four items assessed perceived knowl- edge of privacy settings. These items included: “I feel confident about my knowledge of privacy settings on my social networking sites”; “I am aware of what information is viewable by the public (i.e., nonfriends) on my social networking site”; “There may be information on my social networking page that can be viewed by the public that I did not intend to be publicly viewable”; and “I donot know what information the public can view on my social networking site.” Items were responded to on a 6-point Likert-type scale, with anchors ranging fromStrongly Disagree(1) toStrongly Agree(6). After reverse coding the last two items, responses were summed to form a total score, which could range from 5 to 24.

Higher total scores indicated more reported knowledge of privacy settings. For the current study, the Coefficient alpha was .81, and the scale mean was 17.90 (SD 3.78). Results Descriptive Analyses Before analyzing the research hypotheses, descriptive summa- ries were calculated for online behaviors. Of the 226 participants who endorsed having clinical experience, 75 (33.2%) had used the Internet to find out information about a client, with 44 (19.5%) using social networking Web sites (e.g., Facebook) to obtain information and 66 (29.2%) using a search engines (e.g., Google) to obtain information. Of those who conducted an online search, 16 (21.3%) did so occasionally to very frequently. Of those who conducted a social network search, 11 (25%) did so occasionally to very frequently. It is important to note that participants with clinical experience who conducted these searches on more than a periodic basis reflected less than 1% of the sample. Of the 75 participants who indicated that they had conducted an online client search, 74 provided information regarding their informed consent practices. The majority, 62 (83.8%), reported that they did not discuss how they would handle information that required a breach of confidentiality with the client, 62 (83.8%) reported never ob- taining informed consent prior to online client search, and 64 (86.5%) indicated that they did not document the online search in the client’s file.

Participants’ responses to the disclosure items were analyzed for the 226 graduate students who had clinical experience. Two par- ticipants did not respond to every question. Twenty (8.9%) of the participants endorsed expressing positive thoughts/feelings online about something a client said in session in comparison to 12 (5.3%) who endorsed expressing negative thoughts/feelings online about something a client said in session. Forty-one (18.2%) en- dorsed posting an update online that indirectly referenced positive thoughts/feelings (e.g., happiness, optimism, hopefulness, etc.) they were having about a client.

Hypothesis Testing Missing data exceeded 5% (n 14) for the online client search prediction model (H2); thus multiple imputation was used to account for missing data. All variables in the analysis and auxiliary variables that correlated to variables that were missing were in- cluded in the imputation model. Missing data were less than 5% for the disclosure (H1) prediction model and for the informed consent exploratory analysis. The missing value analyses did not reveal patterns for missingness; thus, these cases were not in- cluded. Because the dependent measures were positively skewed and displayed high levels of kurtosis, the plots of the observed and predicted residuals were examined for each analysis. To reduce heteroscedasticity and non-normality in residual distributions, the dependent variables were transformed using a log transformation. This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 14 HARRIS AND ROBINSON KURPIUS This improved the distribution of the residuals and linearization of the relationships. Because online use differs across age and gender, the first and second hypotheses controlled for these variables by adding them into the first level of the analyses. Program type (e.g., school psychology, counseling psychology) was controlled for in the second hypothesis and the exploratory analysis to rule out possible confounds. Masters students in clinical psychology pro- grams were collapsed into one group with doctoral clinical psy- chology programs because separating them had no predictive value and provided little information because of low sample size (n 11).

Results from the analysis for disclosure of client information online (H1) are summarized inTable 1. The demographics level (age, sex, program) was significantly related to online disclo- sure,F(6, 212) 3.12,p .006. The individual differences level (ethical decision making, years of social networking ex- perience, and knowledge of privacy settings) accounted for significant additional variance,F(9, 209) 4.84,p .001. The full model that included the interaction of program and ethical decision-making was explored in the third level to test for a moderator effect, which was significant,F(13, 205) 4.53,p .001. Disclosure of client information was related to lower scores on ethical decision-making,t 2.10,p .037. En- rollment in a school psychology program as opposed to aclinical or counseling program was positively related to disclo- sure of client information,t 2.87,p .004. However, status in a school psychology program was moderated by ethical decision-making,t 2.67,p .008. In other words, although participants in school psychology group had highest scores overall on disclosure items, they had lower levels of disclosure when ethical decision-making scores were high in comparison with the clinical and counseling groups.

Results from the analysis for online search of client information (H2) are summarized inTable 2. Possible confounding from age, sex, and program type was controlled in the demographics level.

The individual differences level (credits, years of social network- ing experience, and direct client hours) was a significant predictor of online client searches,F(9, 216) 2.52,p .001. Online client searches were positively related to years of social networking,t 2.64,p .008 and to credit hours,t 3.01,p .003. In other words, years of social networking experience and longer presence in a graduate program were related to increased searching for client information. Exploratory Analysis The results from the analysis for obtaining informed consent before an online search are summarized inTable 3. Possible confounding Table 1 Hierarchical Multiple Regression for Disclosure of Client Information Online (n 219) ModelR 2 R 2 BSE B psr 2 1. Demographics .082 Age .001 .001 .275 .07 Sex .004 .021 .862 .01 Program 1 .026 .021 .233 .08 Program 2 .013 .030 .664 .03 Program 3 .041 .022 .063 .12 Program 4 .048 .024 .047 .14 2. Individual differences .173 .092 Ethics c .010 .002 .001 .29 Years SNW .006 .004 .142 .10 Privacy knowledge .001 .002 .790 .02 3. Full model with interactions .223 .049 Age .001 .001 .364 .06 Sex .002 .020 .915 .01 Program 1 .064 .116 .581 .03 Program 2 .294 .235 .211 .08 Program 3 .309 .107 .004 .18 Program 4 .029 .152 .847 .01 Ethics c .006 .003 .037 .13 Years SNW .006 .004 .160 .09 Privacy knowledge .001 .002 .770 .02 Program 1 Ethics c .006 .008 .407 .05 Program 2 Ethics c .020 .015 .184 .08 Program 3 Ethics c .019 .007 .008 .17 Program 4 Ethics c .006 .010 .577 .03 Note.Dummy coding was used for Sex in which male is coded 1 and female is coded 0. The notation Program 1 refers to the dummy code for program type in which counseling psychology is coded “1” and all other groups are coded “0.” The notation Program 2refers to the dummy code for program type in which School Counseling is coded “1” and all other groups are coded “0.” The notation Program 3refers to the dummy code for program type in which School Psychology is coded “1” and all other groups are coded “0.” The notation Program 4refers to the dummy code for program type in which Clinical Psychology is coded “1” and all other groups are coded “0.” The notation Ethics crefers to ethical decision-making. The notation SNW refers to social networking.

Independent measures are centered. p .05. p .01. p .001. This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 15 SOCIAL NETWORKING AND PROFESSIONAL ETHICS from program type was controlled in the demographics level. Because the hypothesis was nondirectional, the alpha was set at .025. The individual differences level (reason for search) approached signifi- cance for online client searchesF(8, 65) 2.30,p .031. Curiositywas the most common reason for conducting an online search about a client and was used as the reference group. Endorsements of therapeutic concern about client welfare,t 2.04,p .045, and gathering information for intervention,t 3.46,p .001, were Table 2 Hierarchical Multiple Regression for Online Search of Client Information (n 226) ModelR 2 R 2 BSE B psr 2 1. Demographics .018 Age .001 .002 .948 .01 Sex .049 .033 .135 .10 Program 1 .025 .034 .467 .05 Program 2 .016 .048 .742 .02 Program 3 .025 .035 .472 .05 Program 4 .009 .038 .806 .02 2. Full model with individual differences .100 .077 Age .001 .002 .490 .05 Sex .057 .032 .078 .12 Program 1 .065 .035 .062 .12 Program 2 .023 .047 .628 .03 Program 3 .015 .037 .679 .03 Program 4 .030 .038 .424 .05 Credits .002 .001 .003 .20 Direct client hours .001 .001 .276 .07 Years SNW .014 .005 .008 .17 Note.Dummy coding was used for Sex in which male is coded 1 and female is coded 0. The notation Program 1 refers to the dummy code for program type in which counseling psychology is coded “1” and all other groups are coded “0.” The notation Program 2refers to the dummy code for program type in which School Counseling is coded “1” and all other groups are coded “0.” The notation Program 3refers to the dummy code for program type in which School Psychology is coded “1” and all other groups are coded “0.” The notation Program 4refers to the dummy code for program type in which Clinical Psychology is coded “1” and all other groups are coded “0.” The notation SNW refers to social networking. p .05. p .01. p .001. Table 3 Hierarchical Multiple Regression for Informed Consent (n 74) ModelR 2 R 2 BSE B psr 2 1. Demographics .047 Program 1 .115 .068 .094 .20 Program 2 .081 .114 .479 .08 Program 3 .025 .067 .706 .04 Program 4 .062 .075 .407 .10 2. Full model with individual differences .220 .174 Program 1 .112 .065 .089 .19 Program 2 .087 .107 .420 .09 Program 3 .044 .063 .488 .08 Program 4 .027 .071 .707 .04 Reason 1Therapeutic concern .141 .069 .045 .22 Reason 2Information for intervention .248 .072 .001 .38 Reason 3Verify what client told me .111 .058 .061 .21 Reason 4Other.014 .093 .883 .02 Note.The notation Program 1refers to the dummy code for program type in which counseling psychology is coded “1” and all other groups are coded “0.” The notation Program 2refers to the dummy code for program type in which School Counseling is coded “1” and all other groups are coded “0.” The notation Program 3refers to the dummy code for program type in which School Psychology is coded “1” and all other groups are coded “0.” The notation Program 4refers to the dummy code for program type in which Clinical Psychology is coded “1” and all other groups are coded “0.” The notation Reason Xrefers to the dummy code for reason for search (e.g., therapeutic concern for client welfare) is coded “1” and all other groups are coded “0.” p .05. p .01. This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 16 HARRIS AND ROBINSON KURPIUS related to obtaining informed consent. Verifying what the client said and reasons endorsed as “other” were not significant predictors of obtaining informed consent. Discussion The Internet has made information increasingly easier to obtain.

In response to an inquiry, search engines such as Google can generate thousands of results within seconds. This ease may well account for the fact that a third of the study sample who had clinical experience sought client information online. This finding is consistent withLehavot et al.’s (2010)findings that approxi- mately a fourth of student psychotherapists seek out client infor- mation online.

The current study explored possible correlates to online searches of client information, including number of credit hours, direct client hours, number of clients seen, and years of social network- ing experience. Credits and years of social networking were sig- nificantly related to online client searches.DiLillo and Gale (2011) reported a positive partial correlation between year in program and endorsement of obtaining information using a search engine and social networking website. The current study had a similar finding.

Credit hours, a measure of progress in ones’ program, was posi- tively related to online client searches. A possible reason for this finding could be that the more advanced individuals are in their graduate program the greater likelihood that they will have en- gaged in online client searches. Interestingly, although credit hours was correlated to online searches, direct client hours was not. This suggests that clinical experience does not appear to have a signif- icant relationship to online searches of client information. How- ever, the sample consisted of graduate students and the range of variability in direct client hours was likely limited compared to those in clinical practice. Of those students with supervised clinical experience, most had completed or were currently enrolled in only one clinical experience (e.g., practicum), which limits the time- frame to only one or two semesters.

Years of social networking experience was also positively re- lated to online client searches. Perhaps familiarity or a comfort with technological mediums is related to a greater likelihood of utilizing these mediums in clinical practice. Although online client searches are not inherently unethical, it is important that counsel- ing and psychology graduate students evaluate how any search for client information affects their client’s right to privacy and ensure client informed consent.

Of the participants who conducted an online client search, more than 80% indicated that theyneverobtained client consent, did not document the search in the client’s file, did not consider the possibility of having to breach confidentiality, and never discussed the benefits and drawbacks of the search with their client. Both the APA (2010)and the ACA (2005) conceptualize informed consent as a fluid rather than static element that should be readdressed as new circumstances warrant. The finding related to obtaining in- formed consent and documenting this consent is alarming in that it suggests potential ethical violations are occurring.

When reasons for online searches of clients were examined, curiosity was the most endorsed reason. Conducting an online client search to satisfy personal curiosity could be considered unethical because it violates clients’ fundamental right to privacy.

Not surprisingly, conducting an online search of client informationfor an intervention or out of therapeutic concern was positively related to obtaining informed consent, further underscoring the importance of examining purpose of mental health professionals’ online searches. The second most reported reason was to verify what the client said in session. This could indicate a lack of trust in the client’s truthfulness or ability to convey information accu- rately. Additionally, if informed consent was not obtained before the search and a discrepancy was found in client’s in-session reports and information obtained online, potential damage to the therapeutic alliance could result.

Some have argued that information online is public; therefore, clients cannot expect their online behaviors to be private. Whether or not the client has an expectation of privacy, the intentionality of the clinician needs to be considered. Although it would be con- sidered reasonable to discuss a chance in-person encounter in therapy where the client was observed doing behaviors related to their treatment (e.g., see client who is being treated for substance abuse at a bar drinking), it would generally be considered unethical to observe clients without their knowledge and consent. This also holds true for the online environment. Even though mental health professionals may unintentionally encounter information about their clients online (e.g., client is featured in a prominently dis- played online news article), purposefully searching out informa- tion without client consent could be considered a violation of a client’s rights.

There were significant differences among participants who com- pleted their clinical experience in a school psychology program and those in clinical or counseling programs, with those in school psychology programs endorsing higher levels of disclosure of client information. This difference may be related to differences in norms for clinical sites. For example, school psychologists may be part of a school’s multidisciplinary team (i.e., member of a group for child’s individualized education plan) and be responsible for conveying test results to parents and appropriate school personnel.

Level of interaction and interconnectedness among personnel in a school setting versus a community clinic or hospital may influence perceptions of acceptability of disclosure. Furthermore, school psychologists are working with minors on behalf of the school; therefore, they are expected to share information with relevant school personnel as well as with parents. It is possible that this results in having more lax boundaries with respect to sharing client information, both in person and online. The moderating role of ethical decision-making in school psychology programs suggests that additional training in ethics might improve inappropriate disclosure levels.

As predicted, lower scores on the ethical decision-making scale correlated with higher levels of disclosure. Although some of the questions in the ethical boundaries scale were blatantly unethical (e.g., planning a relationship with a current client), others involved scenarios that were not as clear-cut (e.g., coming back after your shift is over to check on a client who recently shared distressing information in session). Individuals who rated the ethically ques- tionable in-person scenarios as unethical were also more likely to rate online disclosures of client information under a variety of circumstances as unethical. This suggests that participants who drew a firm line (i.e., endorsed never ethical) for the hypothetical in-person scenarios may be more likely to transfer this stringent practice to their online behaviors. These are self-reported behav- This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 17 SOCIAL NETWORKING AND PROFESSIONAL ETHICS iors and beliefs, however, and may not be accurate reflections of participants’ actual online behaviors.

Limitations of the Present Study Several limitations need to be noted, including the following:

method of survey administration; scale construction; observed effect sizes; and use of a graduate student sample. Although it has become increasingly common to administer surveys online, there is inherent bias in doing so. To complete the survey, the participant had to have a basic familiarity with navigating the Internet, which may have introduced bias given that this study was about social networking use on the Internet. Additionally, the use of survey methods and self-report data can be subject to under reporting as a result of social desirability. It is also important to note that with the exception of the boundaries in practice scale, the senior re- searcher created measures for online behavior. Although the co- efficient alphas indicated adequate internal consistencies for the measures, the construct validity could be strengthened by use of expert raters and having an external sample of practitioners rather than only students. Observed effect sizes were also a limitation.

The models accounted for 10% of the variance (for online search of client information) to 22% of the variance (for online disclosure of client information) suggesting that other important variables are still unaccounted for and should be explored in future research.

Finally, because the sample consisted of graduate students, results cannot be generalized to professionals in clinical practice.

Conclusions In light of the findings of this study, it is clear that mental health graduate students are engaging in activities that are ethically questionable (e.g., conducting an online search without informed consent). Of the 315 participants, more than half reported that they did not believe that their graduate program adequately addressed professional social networking guidelines, and slightly less than half did not believe their professional organization adequately addressed professional social networking guidelines. It is clear that many graduate students are looking for guidance on how to nav- igate ethical dilemmas created by social networking.

Surprisingly, of those who indicated searching for clients online or disclosing client information, a quarter reported that theynever discussed social networking use that related to their clinical work with their clinical supervisor. To minimize or avoid ethical and legal infractions regarding online behaviors, mental health gradu- ate students should seek professional consultation from clinical supervisors, keep careful documentation, and thoughtfully con- sider alternatives. Results of this study indicate that mental health graduate students’ use of social networking in their clinical work warrants further attention from professional organizations and training programs. Discussing technology use in clinical practice and encouraging critical thinking regarding ethically questionable behaviors may reduce potential harm to clients and maintain the publics’ trust in the confidential and nonmaleficent nature of the mental health professional-client relationship. Ethical training could be potentially augmented by including scenarios that encour- age the application of the ethical code in cases that are less clearly defined legally or by respective ethical standards (e.g.,APA, 2010) as “right” or “wrong.”Even though participants may not believe that the information they share online could reveal client identity, it is difficult to distinguish what degree of disclosure would cross the boundary as identifiable. As previously noted, malpractice suits have been brought against members of the medical field for releasing infor- mation that the patient felt could identify them. Furthermore, it is becoming increasingly common for clients to conduct an online search of their mental health professional.Lehavot et al. (2010) found that the majority (70%) of mental health trainees seeing clients were informed by a client that he or she had obtained information about the trainee through the Internet. Imagine the potential damage a therapeutic alliance could suffer if a client found information posted online by their clinician that they be- lieved referenced him/her. Any level of disclosure, even disclosure that the professional does not think is identifiable, runs the risk of violating ethical boundaries. Graduate students need to examine what purpose an online disclosure is serving and whether there is a potential to cause harm to the client. Professional organizations and graduate programs need to address the question of what, if any, client information is acceptable to disclose online.

The responsibility for information that is indirectly obtained through social networking is ambiguous, which underscores the importance of openly discussing with the client the intended ther- apeutic use of social networking. If viewing a client’s social networking page is deemed appropriate by both clinician and client, it is important that mental health professionals are familiar with the state laws regarding when to breach confidentiality.

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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 19 SOCIAL NETWORKING AND PROFESSIONAL ETHICS