Therapist + Social Media = Mental health influencer? Considering the research focusing upon key ethical issues around the use of social media by therapists

Current ethical guidelines for therapists who make use of social media are very limited. As a consequence, they leave much open to interpretation by professionals, an openness that may place the public and professionals at risk. This is particularly of note as therapists are increasingly making use of social media and many professionals are taking on roles as mental health influencers, both purposefully and without realising. Such developments raise many important ethical issues including considerations around influencer competency, integrity, the maintenance of confidentiality and risk management. These issues are briefly discussed in this paper alongside related current research focusing upon them. It is concluded that, despite the existence of ethical guidelines focusing upon social media use by therapists, current research suggests that therapists are not consistently following these guidelines. Moreover, it is argued that researchers and professional bodies, and their associated good practice guidelines, need to keep abreast of new developments to account for changes in social media usage.     

Danger! Psychotherapists at work

The rapid growth of psychotherapeutic movements in recent years has led to a free market. Vast numbers of psychotherapists of different theoretical persuasions are now on offer. While such a choice has its obvious advantages, it creates bewildering confusions in the minds of potential clients. How can the clients tell which psychotherapist or psychotherapeutic entepise to opt for? How can they know whether they have made an appropriate choice? How do they know which therapy works best under which conditions? Are there a set of criteria laid down which might guide the client in making a judicious choice? Can they be assured that after a senes of agreed sessions, they will get better? These are extremely serious issues. The paper discusses the practical and ethical implications underlying these issues and offers specific suggestions and guidelines as to how the clients might safeguard their own interests when it comes to choosing an appropriate psychotherapist.     

Reflections on an Anti-discriminatory Stance in Psychotherapy

Challenges and opportunities for psychologists and psychotherapists in respect to explicit and implicit discrimination issues in therapy are explored, both from the side of the therapist and the client. Furthermore, personal reflections on such issues are discussed drawing on examples of indirect discrimination on the basis of race and sexual orientation. It is suggested that a combination of professional anti-discriminatory guidelines, a willingness to understand deeply the client’s frame of reference and self-reflection can guard against such phenomena that can harm ethical and constructive psychotherapy.     

A third language in therapy: deconstructing sameness and difference

The paper draws on recent research and the first author’s personal story to show what happens when the language difference between therapist and client is brought to mutual awareness in the therapy room. Individual lived experiences of migrant psychotherapists and counsellors and the issues that arise in therapy practice when the practitioners use their second language as the means of communication with clients are explored. The notion of a third language – a dynamic communication system that is a result of developing a professional identity through a second language – is introduced. Unlike the psychoanalytic third, it is often conscious and may be used either defensively or purposefully as a concrete third point of reference in the intersubjective encounter. The paper explores how the concept of a ‘Third Language’ can be used as a tool to negotiate perceived sameness or difference in therapeutic encounters and to build a common language with a client, both literally and metaphorically. The study featured in the paper has implications for practice, theory and research.     

Ethical and Regulatory Considerations for Using Social Media Platforms to Locate and Track Research Participants

As social media becomes increasingly popular, human subjects researchers are able to use these platforms to locate, track, and communicate with study participants, thereby increasing participant retention and the generalizability and validity of research. The use of social media; however, raises novel ethical and regulatory issues that have received limited attention in the literature and federal regulations. We review research ethics and regulations and outline the implications for maintaining participant privacy, respecting participant autonomy, and promoting researcher transparency when using social media to locate and track participants. We offer a rubric that can be used in future studies to determine ethical and regulation-consistent use of social media platforms and illustrate the rubric using our study team’s experience with Facebook. We also offer recommendations for both researchers and institutional review boards that emphasize the importance of well-described procedures for social media use as part of informed consent.     

Ethics for Mental Health Influencers: MFTs as Public Social Media Personalities

The increase in social media usage contributes to a greater number of Marriage and Family Therapists (MFTs) using social media to grow their professional outreach and to increase awareness about mental health by engaging with online audiences. Although existing literature has discussed how MFTs can make ethical use of personal social media in and around their therapeutic role, no literature at this time has explored the potential ethical issues faced by MFTs seeking to build public presence on social media as a “mental health influencer.” The present paper intends to provide a definition of mental health influencers (MHIs) and reviews ethical concerns relevant to MFTs acting as MHIs. Particular consideration is given to ethical dilemmas and conflicts-of-interest which may emerge via parasocial relationships developed through social media influencing, as well as how the boundaries and the limitations of an MFT’s professional scope can be tested when presenting as a personable, public figure over digital platforms. A framework for conceptualizing ethical issues for MHI-MFTs is offered, with a selection of prescient issues being examined within the scope of existing ethical standards set forth by the American Association of Marriage and Family Therapy’s (AAMFT) Code of Ethics. Reflections are offered about what questions and guidelines should be observed by MFTs in order to avoid unethical use of social media as an MHI, followed by a brief discussion about future considerations which should be considered by MHIs.

     

Integration sozialarbeiterischer Kompetenz in die psychotherapeutische Versorgung

Social and socioeconomic issues are a risk factor for the development of mental health problems and have the potential to negatively impact the psychotherapeutic treatment process. In addition, mental disorders can also result in socioeconomic stress. Neither professional training nor parameters of everyday practice of medical or psychological psychotherapists are geared towards acquiring sufficient competence to adequately handle complex social problems of highly impaired patients. Especially in times of social crises, three interrelated strategies may be helpful: to enhance psychotherapists’ sensibility and competence to recognize and deal with severe social crises, to promote cooperation with clinical social workers and to incorporate sociotherapeutic elements in the overall treatment planning. Using an approach of integrated care at a university medical department as an example, this article presents examples of how to implement these strategies into everyday therapeutic practice.     

Clinical strategies to promote compliance

Abstract

This article focuses on the need for effective client management throughout the therapeutic process. The appropriate and astute use of clinical strategies can promote client compliance with treatment and counteract the possibility of client dissatisfactions and ethical/legal complaints. This article offers a systemic explanation of compliance, identifies five major clinical strategies to foster treatment adherence, and discusses the need for clinical judgments that fulfill ethical/legal obligations while promoting quality care.     

E-Therapy: Ethical Considerations of a Changing Healthcare Communication Environment

This paper outlines the current ethical guidelines for electronic therapy services, and the sufficiency and implications of these guidelines in a culturally diverse population as found in the United States. The paper limits the discussion of ethical deliberations to: what is considered adequate competency to practice mental health therapy electronically; the disclosure and identity verification requirements; confidentiality issues when different social norms exist; the social responsibility of public institutions or individuals; and issues that relate to miscommunication due to different cultural or educational backgrounds. It concludes that since E-Therapy helps to reach underserved populations and significantly reduces costs associated with mental health services, compliance with ethical guidelines must be enforced to benefit from the latest communication technologies. This paper is relevant for various professions related to psychology and psychotherapy, including pastors and pastoral counselors, because various forms of E-therapy are emerging in the 21st century and can serve as resources for “E-pastoral counseling.”     

Is touch a valid therapeutic intervention? Early returns from a qualitative study of therapists' views

Findings are reported from six semi‐structured interviews with experienced psychotherapists, focusing on the reasons for using touch and the sort of touch used. They suggest that there is a distinction being made by therapists between ‘social space’ and ‘therapeutic space’, and a different view of touch taken if it is judged by the therapist to be ‘out of the therapeutic environment’. Whether or not touch was initiated by the therapist or the client would also appear to influence its further discussion by the therapist, either in processing it with the client or in supervision. What also emerged from the interviews was the finding that an exploration of touch in supervision was unusual. The implications for practice, supervision and training are discussed as areas for further exploration in the main survey, which will be conducted in the second year of the research.     

Tele‐analysis: the use of media technology in psychotherapy and its impact on the therapeutic relationship

A growing number of approaches in psychotherapy make use of internet‐ and other media‐based interactions. This paper discusses the impact on the therapist‐client relationship of using media technology and gives an overview of the current state of the debate. It is suggested that the technical conditions of internet‐based interactions produce new forms of social relationships that differ significantly from face‐to‐face‐interactions and that unconscious, nonverbal cues get lost. Research on the therapeutic interaction making use of ‘discourse linguistic’ methods is presented. The loss of nonverbal cues has implications for psychotherapy in general and especially for the treatment of patients who have difficulties relying on a secure therapeutic relationship. Emotional security in interactional relationships is transmitted to a much greater extent by nonverbal cues than by verbal content; psychoanalytic methods are specialized to refer to this level of interaction. Two alternative scenarios are discussed based on the psychoanalytic theories of Winnicott and Lacan: the risk of an illusionary, idealized image of the other and the possibility that cyberspace can be used for psychological development as a transitional space.     

Psychotherapeuten und Internet

Background

Communication is part and parcel of every interaction. This raises the question of the role of modern media in mental health care. The aim of this explorative study was to investigate the use of modern media in the clinical practice.

Material and methodology

In an Internet survey 234 psychotherapists from Nordrhein-Westfalen (NRW) were surveyed about the extent to which they integrate new media in the practice and their opinion about this integration. For this purpose a questionnaire was developed based on the questionnaire of Wangberg et al. (2007).

Results

Most of the psychotherapists already use e-mails as well as mobile communication to contact their patients. The main reason for choosing this modern way of communication is the possibility to simplify the management of formal issues. Psychotherapists were indifferent about the idea of web-based counseling.

Conclusion

Forms of digital media are used as an addition to conventional ways of therapeutic communication but face-to-face interaction cannot be replaced completely which is also indicated by the fact that professionals still highly value personal contact.     

Ethically Problematic Value Change as an Outcome of Psychotherapeutic Interventions

Values nonpaternalism—the ethical imperative to avoid imposing values onto clients—is implicit in most widely used ethical frameworks employed by psychotherapists. Although changes in client values may represent desired psychotherapeutic outcomes, some such changes may be ethically problematic. Interventions are characterized by values paternalism when they are intended to promote client welfare but are accompanied by impositions against client values. Providers and consumers of psychotherapy may routinely lack awareness of this consideration. Psychotherapists may have a duty to be informed about ethically problematic value change accompanying psychotherapy and to inform clients about this phenomenon.     

The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!

Abstract

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.

A survey of psychological therapists who worked in primary care showed that the incidence of psychotherapists being harassed or stalked by their current or former clients was more than twice the national average at 24%. The stalkers fell into three broad categories: those clients who were needy and made early attachments to their therapists; those experiencing erotic transference; and those with personality disorders, especially those with a narcissistic style. All of these are disorders of attachment. This paper discusses the neurobiological development of an insecure attachment and how that manifests during therapy in stalking behaviour. Psychotherapists who are aware of the dynamics within the therapeutic relationship can take preventative steps to inhibit the automatic fear response of a client who is insecurely attached and which may lead to stalking behaviour.     

Scientists’ Ethical Obligations and Social Responsibility for Nanotechnology Research

Scientists’ sense of social responsibility is particularly relevant for emerging technologies. Since a regulatory vacuum can sometimes occur in the early stages of these technologies, individual scientists’ social responsibility might be one of the most significant checks on the risks and negative consequences of this scientific research. In this article, we analyze data from a 2011 mail survey of leading U.S. nanoscientists to explore their perceptions the regarding social and ethical responsibilities for their nanotechnology research. Our analyses show that leading U.S. nanoscientists express a moderate level of social responsibility about their research. Yet, they have a strong sense of ethical obligation to protect laboratory workers (in both universities and industry) from unhealthy exposure to nanomaterials. We also find that there are significant differences in scientists’ sense of social and ethical responsibility depending on their demographic characteristics, job affiliation, attention to media content, risk perceptions and benefit perceptions. We conclude with some implications for future research.     

Innovation in Technology-Aided Psychotherapy Through Human Factors/Ergonomics: Toward a Collaborative Approach

Technologies are being used increasingly to aid psychotherapy and are becoming an integral part of mental health treatment. Although prior studies compared technology-aided psychotherapy (TAP) to traditional treatments, there are insufficient studies of the impact that specific design parameters and use of the technologies may have on the client and therapist, and treatment outcomes. This requires an understanding of human–technology interaction, which is the focus of the field of Human Factors and Ergonomics (HF/E). The goal of this article is to raise awareness of the importance of the human–technology interaction in TAP, and to foster collaborations between psychotherapists and HF/E professionals. Toward these aims, this article examines the implications of findings in HF/E for the use of technologies (videoconferencing, text-based communication, and virtual environments) in psychotherapy. It is suggested that the manner in which technologies are designed and used may have important effects on the therapeutic alliance and treatment outcomes, and in some cases (side effects of virtual reality) the health and safety of the client. Future research should examine effects of specific design factors on treatment including variables such as the visibility of gestures and degree of eye contact during videoconferencing, response delays during text-messaging, and presence and adverse effects when using virtual environments. Studies that compare TAP to traditional methods should report as much detail as possible about the human–technology interaction. It is essential that psychotherapists and HF/E professionals conduct research collaboratively to develop effective and innovative technologies and, ultimately, design principles for TAP.     

A Positive and Proactive Approach to the Ethics of the First Interview

Some may view the initial interview as a mechanistic procedure complete with a list of tasks to accomplish. The primary purpose of this article is to deconstruct this perspective and encourage psychotherapists to explore the initial interview through an ethical acculturation lens. Using a case scenario, we demonstrate the need for purposeful reflection to better understand important judgments and choices psychotherapists make while conducting initial interviews. Employing a proactive approach to ethics using a “wide-angle” lens, we organize the discussion around personal, professional, and global themes. We offer practical tips to facilitate ethical excellence as psychotherapists engage in their first client contacts.     

Protecting Human Health and Security in Digital Europe: How to Deal with the “Privacy Paradox”?

This article is the result of an international research between law and ethics scholars from Universities in France and Switzerland, who have been closely collaborating with technical experts on the design and use of information and communication technologies in the fields of human health and security. The interdisciplinary approach is a unique feature and guarantees important new insights in the social, ethical and legal implications of these technologies for the individual and society as a whole. Its aim is to shed light on the tension between secrecy and transparency in the digital era. A special focus is put from the perspectives of psychology, medical ethics and European law on the contradiction between individuals’ motivations for consented processing of personal data and their fears about unknown disclosure, transferal and sharing of personal data via information and communication technologies (named the “privacy paradox”). Potential benefits and harms for the individual and society resulting from the use of computers, mobile phones, the Internet and social media are being discussed. Furthermore, the authors point out the ethical and legal limitations inherent to the processing of personal data in a democratic society governed by the rule of law. Finally, they seek to demonstrate that the impact of information and communication technology use on the individuals’ well-being, the latter being closely correlated with a high level of fundamental rights protection in Europe, is a promising feature of the socalled “e-democracy” as a new way to collectively attribute meaning to large-scale online actions, motivations and ideas.     

Issues relating to the use of forgiveness in counselling and psychotherapy

This paper explores forgiveness, which is a key component of spiritual pastoral care. Encouraging forgiveness is also one of the spiritual interventions most frequently used by psychotherapists. However, although forgiveness has been explored as an element in psychotherapy, the models generated have had little impact on research and practice. Recent research into forgiveness in therapy is considered, including several models put forward for its use. Some of the implications of the use of forgiveness in therapeutic practice are examined and guidelines for the use of forgiveness in psychotherapy are put forward based on the work of the Forgiveness Project at the University of Manchester.