The accelerating development of personal communications technology means that psychologists won't necessarily meet with all their clients face-to-face for therapy in the near future, said APA President Gerald P. Koocher, PhD, during his presidential address at APA's 2006 Annual Convention.

Telepsychology, he said, will pose ethical challenges for psychologists who deliver therapy to clients who are hundreds or even thousands of miles away, through such means as e-mail and videoconferencing.

As technology advances and some clients choose to communicate with their therapists electronically, Koocher said, questions of how to organize and oversee the rapidly evolving field while meeting psychology's ethical demands will emerge in four areas:

  • Contracting. How will administrative procedures for record-keeping and client informed consent work for telepsychology? Will fees for therapy conducted electronically be the same as for office-based services?

  • Competence. What types of therapy can be effectively delivered electronically? What are the standards for competence for working with clients remotely?

  • Confidentiality. Since information communicated electronically can be intercepted, what should the standards of encryption be?

  • Control. If a psychologist conducts therapy electronically with a client living in another state, what licensing board will conduct an inquiry if a complaint arises?

On the topic of confidentiality, Koocher noted that just as technology brings the possibility of delivering therapy in a new way, it also provides a channel for intercepting what used to be confidential information passed between a therapist and client in person.

Through such electronic intercept programs as Carnivore and Echelon, U.S. government agencies are reportedly able to capture e-mail messages and sift through countless telephone calls, faxes, e-mails and telex messages, looking for key words, he said.

The invisible psychologist

Other growing roles for psychologists that Koocher predicted will also con-tinue to create ethical challenges are "invisible psychologists"-such as those who apply the insights of behavioral science to advertising, or who help attorneys with jury selection for the courts. In such situations, the psychologist's role is invisible to the person who is the object of attention and the psychologist's client is a third party, Koocher explained.

Koocher noted that the practice can be a force for what some would consider harmful, such as psychologists who assisted with focus groups and helped the R.J. Reynolds Tobacco Company sharpen the appeal of a planned menthol cigarette line called "Uptown" to African Americans in the late 1980s. Koocher contrasted that example with a hypothetical situation, where a psychologist could be called in to help police with a hostage standoff. Using information gleaned from family members, the psychologist could engage the hostage-taker emotionally, giving police time to rush in and peacefully disarm him.

Instead of heeding calls from some to forbid psychologists to work in such areas as advertising, the discipline should continue to emphasize ethical standards while helping psychologists who perform third-party work make ethically valid choices.

"We should not become a tool for advancing narrow political or social agendas," he said.

Looking to the future, Koocher also cautioned practitioners in another growing domain-psycho-pharmacology.

As the number of psychologists with postdoctoral credentials in psychopharmacology who can prescribe grows, the field should avoid the pitfalls ignored by psychiatry. Koocher described those pitfalls as losing competence in the skills valued by clients: the scientific foundation in assessment, psychotherapy and other nonmedical interventions.

In fact, he predicted psychiatry will disappear as a medical specialty in the next several decades as the aging population of baby boomer psychiatrists retire, and more psychologists gain prescriptive authority.

"Reaching for a prescription pad is easier than conducting a well-founded assessment and expert psychotherapy," he said. "The demands of the marketplace may make it more lucrative to prescribe than to talk, but we should strive to avoid that model."