Ethics Rounds

One of the most pleasurable and rewarding aspects of directing the Ethics Office at APA is traveling throughout the country and speaking with students and trainees about the ethical challenges that arise in their work. Some aspects of our ethics remain in relatively constant form: Using a professional relationship for sexual gratification in any manner is always unethical and psychologists may never provide false information to those who pay for their clinical services or fund their research. It is important for psychologists to be clear about these bedrock ethical rules. Surrounding these fixed and firm standards are areas of ethical complexity, where a measure of ambiguity arises and rules must be interpreted and applied to specific situations.

Last year, speaking with a particularly gifted and engaged group of interns and postdocs in Boston, I had a discussion about the ethical dimensions of personal disclosures on the Internet that I found interesting for a number of reasons. First, while I had intended to ask about the group's involvement on the Internet in a passing manner since we had a number of other topics to discuss, I was taken by how nearly everyone at the table had placed some significant amount of information on the Internet in one forum or another. I had simply not appreciated the degree of engagement over the Internet in this cohort. Second, I was struck by the ease and comfort of the discussion, which suggested that this manner of making personal information available was very much part of the social fabric of their lives. Third, I found myself wondering whether using the Internet in this manner was presenting new ethical dilemmas that we as a field have not yet thought our way through or, in the alternative, whether the discussion presented a variation on more familiar themes.

Most psychologists who received their degrees in the recent past, say before 2000, will recall discussions in graduate school about the relationship between events in their personal lives and events in their professional lives. That relationship-between the public and the private-would focus on ways that the personal and the professional intersect; a Venn diagram can be a useful way of thinking about this issue. The range of possible points of intersection was relatively limited. Being seen at a social gathering or serving in some social role at a school, church or club were often given as examples.

Another example that generated a good deal of discussion in my class was political activism, which was seen as different from these others for two reasons: It directly revealed a psychologist's political point of view and significantly raised the psychologist's profile. Yet, the nature and potential dissemination of personal information over the Internet dwarfs the most extreme examples we ever considered in class.

DISCUSSION VIGNETTE

The director of a clinical training program, Dr. Net, has been hearing more and more about interns discussing their profiles, pictures and blogs on sites such as "mylocation.com" and "searchingforlove.com." Some of the personal information the students disclose on these sites includes their interests and information about their families, as well as what they look for in a date and descriptions of good (and bad) dates. Dr. Net is also aware that the interns are occasionally active in online chat rooms and other participatory Internet sites. Dr. Net believes it is important to get the students to think about the implications of providing personal information about themselves in a public forum, but also doesn't want to intrude on their privacy, especially since these are now such common activities for individuals this age.*

*Discussed by the APA Ethics Committee at the 2006 APA Annual Convention in New Orleans.



The nature of the information posted is often highly personal, of the sort one shares with friends or family. The dissemination of the information is to anyone who has an interest and Internet access. The combination of the nature of the information and its broad dissemination raises questions that merit both clinical and ethical consideration.

The Ethics Office at APA receives many calls from both psychologists and clients. In the past year a former client contacted the office, disturbed by what had occurred in a treatment. The client had formed a strong attachment with romantic and erotic feelings toward his treating psychologist. The psychologist had made some personal disclosures about her own relationships that were of unclear clinical utility to an outside observer and that had overly stimulated the client. At least partially in response to these disclosures the client searched the Internet for his therapist, and discovered that the psychologist had a Web site with highly personal information, including pictures of her in a revealing bathing suit. At that point the client realized that treatment was no longer possible, apparently before the psychologist did.

Having terminated the treatment, the client reached out to the Ethics Office in an effort to understand whether what had occurred in his treatment was ethically appropriate. My discussions with the client focused on his experience of learning this information both from the psychologist herself and from the Web site she had created. From my perspective, the ethical and clinical aspects of this psychologist's behavior were closely tied to one another. As far as I could tell, having heard only one side of the story, the psychologist was not aware of-and had not taken sufficient time to consider-the possible effect of her disclosures, either in the therapy or over the Internet, on this client and the client's treatment.

As treating psychologists, we pay great attention to what information gets revealed, and to whom. We pay attention in this manner because as psychologists we recognize that both the "what" and "to whom" questions have clinical significance. Attending to these questions has ethical significance as well, because disclosing information that has a reasonable likelihood of becoming available to clients can facilitate, or significantly hinder, our ability to exercise beneficence in a professional relationship.

The Internet is a powerful tool that makes information available to any interested individual. Placing information on the Internet in any forum, whether a listserv, a blog or a personal Web site, provides the occasion for psychologists to reflect on why they are choosing to make this information available. There are mechanisms that limit who will have access to the information, but ample evidence is available that such measures afford some, but not perfect protection. For this reason, psychologists placing information on the Internet should reflect not only on the nature of the material they post, but also on the possible impact such information will have on their professional work. And of course, quite apart from information we may choose to place on the Internet, is information that is there about us, over which we have little if any control.

Our Ethics Code is of limited value in providing specific guidance about placing information on the Internet. Rather than telling psychologists what they may and may not post, the code orients psychologists toward an attitude of reflection. Central to our ethics is considering how our actions are going to affect others, most especially those with whom we have professional relationships. These considerations are inherently a psychological endeavor; we are inevitably most ethical when we are most psychologically minded. Thoughtful reflection on how information we choose to make available over the Internet may affect others, and why we choose to disclose particular information in this venue, has deep roots in the ethics of our profession.

Further Reading

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Previous "Ethics Rounds" columns can be found at www.apa.org/ethics, in the "From the Director" section.