Patient-targeted googling by psychological therapists: A narrative review of the literature and ethical implications

Background

“Patient-Targeted Googling” (PTG) refers to a healthcare professional using the Internet to discover information about a patient. The present review explores PTG by psychological therapists. The review focused on the prevalence of PTG, how often consent is sought from the patient, and the motivations for and consequences of PTG.

Method

A narrative literature review of published PTG studies was undertaken. Potentially eligible studies were identified by searching PsycINFO, PsycARTICLES, Psychology and Behavioural Sciences Collection, and MEDLINE. Results were screened for suitability for inclusion in the sample (n = 9). All studies were appraised for quality using a structured tool developed for this review.

Results

PTG prevalence rates ranged from 20% to 98%, with rates of non-consent ranging from 60% to 84%. Motivations for PTG included curiosity, to gather new information and to verify existing information. Consequences of PTG included enhancing the therapist's sense of safety and causing harm to the therapeutic relationship.

Discussion

Current literature on PTG is limited and focussed largely in the United States. This review revealed no published PTG studies including UK-based psychological therapists, as well as issues in defining and operationalising PTG. Further research is needed to understand the prevalence of PTG by UK-based psychological therapists, as well as the motivations behind, and consequences of, PTG. This evidence base will inform the development of PTG professional guidelines and training, neither of which currently exist for therapists practising in the UK. Both would be timely given the increasing move of the therapeutic frame to the online environment due to the COVID-19 pandemic.     

Parental consent for psychological evaluations: Legal,ethical and practical considerations

This article explores the legal, ethical, and practical considerations underlying the requirement for acquiring parental consent prior to a psychological assessment of children in school settings. Publ. L. 94-142 now mandates that parents for all children potentially labeled as handicapped give permission for a preplacement evaluation. This article reviews in detail specific aspects of that mandate, argues that this procedure be generalized to all situations where psychologists propose to evaluate children by reviewing both current ethical codes and standards for practice and public policy which favors such an undertaking. Finally, the authors indicate methods for implementing the mandate by discussing such issues as who should obtain consent and what information parents should receive prior to giving consent.     

Children with AIDS in the public schools: The ethical issues

The question of whether to allow children with AIDS to attend public school generates explosive emotions and has wide-reaching consequences. This paper focuses on the perspective of parents of well children who may be asked to attend school with children who have AIDS. These parents are poised at the heart of the dilemma: they are the ethical “bottom line,” and an argument that fails to satisfy them ought not to satisfy anyone. The conflicting commitments these parents face are first to the parentchild covenant which requires them to act in their child's best interests, and second, to the principles of beneficence and justice, which require them not to further burden a sick child with ostracism and isolation. Almost exact parallels exist between this issue and that of proxy consent by parents for children's participation in low-risk, non-therapeutic research. The lengthy and important debate between Paul Ramsey and Richard McCormick on this question is analyzed, concluding that McCormick's position in favor of thoughtful proxy consent is the more compelling. Returning to the question of allowing children with AIDS to attend school, the essay shows why the parallels are persuasive. On the ethical level, the apparent conflict of obligations is almost exactly the same; on the pragmatic level, the essay shows why sharing a classroom with a child who has AIDS is comparable to the “low-risk” category that the National Commission for the Protection of Human Subjects found acceptable in its 1978 guidelines. The essay concludes that parents of healthy childrenmay and ought to accept the presence of children with AIDS in the public school.     

When clients want to pay more for psychotherapy: ethical issues and implications

One ethical issue that commonly comes up in clinical practice is the negotiation of fees with clients. Although the APA Ethics Code provides standards regarding clients who are unable to or do not pay (Standard 6.04), little guidance is given pertaining to fee limits for clients who want to pay more. This issue is explored using a real case example, including the relevant ethical codes to be considered. The necessary “gray” areas of ethical decision-making are demonstrated through my own decision process. Implications for future scenarios are discussed.     

The unconscious pursuit of emotion regulation: implications for psychological health

Because of the central involvement of emotion regulation in psychological health and the role that implicit (largely unconscious) processes appear to play in emotion regulation, implicit emotion-regulatory processes should play a vital role in psychological health. We hypothesised that implicitly valuing emotion regulation translates into better psychological health in individuals who use adaptive emotion-regulation strategies. A community sample of 222 individuals (56% women) who had recently experienced a stressful life event completed an implicit measure of emotion regulation valuing (ER-IAT) and reported on their habitual use of an important adaptive emotion-regulation strategy: cognitive reappraisal. We measured three domains of psychological health: well-being, depressive symptoms, and social adjustment. As hypothesised, individuals who implicitly valued emotion regulation exhibited greater levels of psychological health, but only when they were high in cognitive reappraisal use. These findings suggest that salutary effects of unconscious emotion-regulation processes depend on its interplay with conscious emotion-regulation processes.     

Status-based rejection sensitivity among asian americans: implications for psychological distress

We examined whether anxious expectations of discrimination among Asian Americans can help explain this group's elevated levels of internalizing symptomatology, such as lower self-esteem (Twenge & Crocker, 2002) and higher depressive symptoms (Okazaki, 1997, 2002) relative to European Americans. Study 1 reports on the development and validation of a scale measuring status-based rejection sensitivity among Asian Americans (RS-A). In Study 2, scores on the RS-A were related to spontaneous discrimination attributions specifically in situations where discrimination is both applicable and possible for Asian Americans. Study 3 revealed that shame mediated the relationship between RS-A and internalizing symptomatology. Implications for well-being and intergroup interactions are discussed.     

Cultural practices of Hispanics: implications for the prevention of AIDS

Hispanic Americans have one of the highest rates of HIV seroprevalence among all ethnics groups in the US, with high rates being especially noticeable among women and children. Were it known which cultural factors have the most influence on whether Hispanics engage in high-risk behavior for HIV transmission, prevention interventions could be targeted accordingly. To that end, this study was mounted to identify which Hispanic cultural factors relate to condom use. 117 males and 73 females aged 17-56 years of mean age 25.67 were surveyed in Washoe county, Nevada. These mostly young adults had recently immigrated to the western US. It was initially posited that fate orientation, male- female relationships, family relationships, machismo behavior, and religion would have equal influence with respect to condom use. Analysis found that condom use was largely associated with and determined by men who are the principal buyers of condoms. A machismo attitude toward protecting women by using condoms was also associated with condom use. Neither fate orientation with respect to AIDS, nor religion were important determinants of condom use, even though 86.5% of the respondents were Catholic. The degree to which respondents adhered to traditional Hispanic cultural values was influenced by the degree of education and acculturation. On the basis of these findings, the authors suggest targeting AIDS prevention messages to males, while emphasizing the protection of women through condom use. They also suggest that both education and acculturation levels be assessed before implementing prevention programs.     

Fear of AIDS: Its meaning and implications for clinical practice

Clinical reports have appeared about patients who present for mental health treatment with the major symptom of fearing that they have AIDS. The clinical reports of patients who fear AIDS are similar to those made many years ago by patients who feared syphilis. As with the syphilophobia of years ago, the AIDS group represents a divergent set of patients. Some can be described as the worried well who have realistic concerns because of a recent history of high risk behavior; others have unrealistic fears that are secondary to a major mental disorder such as hypochondriasis, depression, or schizophrenia. Suggestions are made to psychotherapists who encounter patients presenting with the problem of fearing AIDS.The views expressed here do not necessarily represent those of the Pennsylvania Psychological Association     

Control groups in psychosocial intervention research: ethical and methodological issues

This article summarizes a National Institute of Mental Health (NIMH) workshop that was convened to address the ethical and methodological issues that arise when conducting controlled psychosocial interventions research and introduces 6 thoughtful and inspiring papers presented by workshop participants. These papers, on topics ranging from informed consent to ethnic minority issues, reflect the depth and breadth of expertise represented by the multidisciplinary group of scientists and ethicists present at the meeting. More extensive follow-up, particularly from federal research applications and publications, of how investigators balance the need for strong research design with ethical considerations may help advance the science of psychosocial intervention research.     

A neurocognitive model of the ethical decision-making process: implications for study and practice

The field of business ethics is entrenched in a cognitive approach that portrays the ethical decision-making process as a completely deliberate and reasoned exercise. In light of growing concerns about the veracity of this approach, I build upon current knowledge of how the brain functions to present a neurocognitive model of ethical decision making. The model suggests that ethical decision making involves 2 interrelated yet functionally distinct cycles, a reflexive pattern matching cycle and a higher order conscious reasoning cycle, and thereby describes not only reasoned analysis, but also the intuitive and retrospective aspects of ethical decision making. The model sparks research in new areas, holds significant implications for the study of ethical decision making, and provides suggestions for improving ethical behavior in organizations.     

Stimulus-response compatibility and psychological refractory period effects: implications for response selection

The purpose of this paper was to provide insight into the nature of response selection by reviewing the literature on stimulus-response compatibility (SRC) effects and the psychological refractory period (PRP) effect individually and jointly. The empirical findings and theoretical explanations of SRC effects that have been studied within a single-task context suggest that there are two response-selection routes—automatic activation and intentional translation. In contrast, all major PRP models reviewed in this paper have treated response selection as a single processing stage. In particular, the response-selection bottleneck (RSB) model assumes that the processing of Task 1 and Task 2 comprises two separate streams and that the PRP effect is due to a bottleneck located at response selection. Yet, considerable evidence from studies of SRC in the PRP paradigm shows that the processing of the two tasks is more interactive than is suggested by the RSB model and by most other models of the PRP effect. The major implication drawn from the studies of SRC effects in the PRP context is that response activation is a distinct process from final response selection. Response activation is based on both long-term and short-term task-defined S-R associations and occurs automatically and in parallel for the two tasks. The final response selection is an intentional act required even for highly compatible and practiced tasks and is restricted to processing one task at a time. Investigations of SRC effects and responseselection variables in dual-task contexts should be conducted more systematically because they provide significant insight into the nature of response-selection mechanisms.     

Establishment and replication of emotion regulation profiles: implications for psychological health

Background and Objectives: A promising method of capturing the complex nature of emotion regulation is to assess composite profiles of regulation (i.e., default pattern of regulation across multiple strategies). However, it remains unclear whether regulatory profiles demonstrate consistency across samples and in relation to mental health. Design: Two studies are presented here. Both utilized a cross-sectional design, and the second study presents a replication of the first. Method: Both studies utilized self-report data from independent undergraduate samples to perform latent profile analyses of emotion regulation use. Results: Studies 1 and 2 demonstrated evidence for four replicable regulatory profiles: Adaptive, Accepting (with or without Suppression), Non-accepting, and Maladaptive. Profiles were also related to symptoms of depression and anxiety, such that those consistently relying on adaptive strategies reported lower symptoms than those relying more heavily on maladaptive strategies. Conclusions: These findings clarify previous work which tied regulatory profiles to psychological health by extending a person-centered approach to understanding the ways in which individuals regulate their emotions.     

Beliefs about emotion: implications for avoidance-based emotion regulation and psychological health

People’s beliefs about their ability to control their emotions predict a range of important psychological outcomes. It is not clear, however, whether these beliefs are playing a causal role, and if so, why this might be. In the current research, we tested whether avoidance-based emotion regulation explains the link between beliefs and psychological outcomes. In Study 1 (N?=?112), a perceived lack of control over emotions predicted poorer psychological health outcomes (increased self-reported avoidance, lower well-being, and higher levels of clinical symptoms), and avoidance strategies indirectly explained these links between emotion beliefs and psychological health. In Study 2 (N?=?101), we experimentally manipulated participants’ emotion beliefs by leading participants to believe that they struggled (low regulatory self-efficacy) or did not struggle (high regulatory self-efficacy) with controlling their emotions. Participants in the low regulatory self-efficacy condition reported increased intentions to engage in avoidance strategies over the next month and were more likely to avoid seeking psychological help. When asked if they would participate in follow-up studies, these participants were also more likely to display avoidance-based emotion regulation. These findings provide initial evidence for the causal role of emotion beliefs in avoidance-based emotion regulation, and document their impact on psychological health-related outcomes.     

Inter-faith relationships in Great Britain: prevalence and implications for psychological well-being

Britain is increasingly multicultural, with greater potential for mixing between individuals of differing religions. While both religion and romantic partnerships offer benefits for psychological well-being, religious heterogeneity in a relationship may be detrimental. This study aimed to investigate the prevalence of interfaith partnerships using the UK Household Longitudinal Study, and explore impact on well-being. Over one-fifth of individuals were in heterogeneous relationships, this was associated with greater psychological distress. The results suggest a need for further research into the mechanisms by which religious mixing in relationships impacts upon health in order to best support an increasingly religiously diverse Britain.