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A Model for Counseling Ethics in the Digital Workplace
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A Model for Counseling Ethics in the Digital Workplace

06/02/14
By Steven M. DeMille, LCMHC
Mellivora Group

The impact of technology in the workplace and in our personal lives is ubiquitous. As you read this article about the digital workplace, examples of these changes will run through your mind. From the use of emails for quick communications to video conferencing, social media, the Internet, and smartphones, the list goes on. The impact is clear. 


It is also no secret that personal tech advances quicker than our workplaces and far faster than our professional ethics standards. As a result, clinical mental health counselors will often find themselves in unpredictable and precarious ethical situations. 

DeMille will be presentinga three-hour pre-conference workshop on “Counseling in a Digital Era: Ethically Navigating Technology in the Workplace” at AMHCA’s Annual Conference in Seattle on Thursday, July 10.
Early in my career I began working with adolescents, and I quickly and frequently found myself faced with digitally related ethical dilemmas. I discovered that there were not clear answers for many of the dilemmas I faced. Even more unnerving was realizing that by the time the counseling profession began addressing those dilemmas, I would be encountering a brand new series of digitally related dilemmas. 

The need for a process instead of a concrete set of standards became apparent to me as I traveled to present and consult on digital ethics. I found that each time I presented or consulted, one or more of the participants would bring up a dilemma that never occurred to me, or someone identified an exception to a proposed digital ethical standard. Digital ethics became an elusive and evasive target. 

It was at this point that I realized I was never going to find a roadmap or specific set of guidelines that would always be available to help me ethically navigate the digital workplace. I was going to have to rethink how to ethically manage the digitally related aspects of my clinical counseling practice.

Recommendations for the
Ethical Use of Social Media

One of the common questions I receive around digital boundaries—and the first ethical dilemma I experienced as a new professional—is how to handle “friend” requests from current or past clients.

Opinions on this topic vary greatly, with some believing clinical mental health counselors should not have a social media presence, and others believing it’s fine for CMHCs to give advice and feedback to clients through social media.

The many different beliefs and practices around socializing online, held by clients and CMHCs alike, are at least partly a result of whether or not an individual grew up with technology.

For counselors choosing to maintain a social media presence, here are some recommendations to help maintain healthy professional boundaries:
  • Keep professional and personal relationships separate.
  • If you interact with clients through social media, develop separate profiles—have a personal profile and a professional profile.
  • Inform clients about some of the benefits and limitations of communicating through social media, and set clear boundaries around appropriate use.
  • Take precautions not to disclose personal information about clients through social media.
  • Clearly define the nature of your online relationship to current and past clients.
  • Be able to justify and document your rationale for having or not having client relationships through social media.

Since that initial realization, I no longer rely on or hope for a specific roadmap to show me how to manage digital ethics. Instead, I now use a decision-making model to protect my clients and myself. 

So in lieu of telling you what I see as the specific optimum digital ethical standards, to which you will likely find dozens of reasonable exceptions, here are the stages that a clinical mental health counselor can walk through with a client or group when addressing digital ethics or concerns. 

(For examples of ethical dilemmas about the use of social media and Internet searches, see the information in the adjacent box (social media) and the one below (Internet searches).)
 
A Six-Stage  Decision-Making Model
Stage 1 

The first step is to collaboratively (in consultation or supervision) identify and define potential digital vulnerabilities in your practice. This is a big project and so it’s important that it be a collaborative process. Some common digital vulnerabilities include:
  • Facebook and other social media sites
  • Emails and text messaging (digital communication)
  • Google (Internet searches)
  • Negative posting online (Yelp, Rate my Professor, etc.)
Not everyone has the same risks or digital vulnerabilities. Each counselor needs to be aware of the ethical vulnerabilities specific to his or her own practice. 

For example, do you use a smartphone? If your smart phone contains protected personal information, how are you securing the information? Do you receive texts on the phone, and if you do, how do you respond to a text from a client? 

All of these questions are relevant if you use a cell phone or smartphone for your practice. If you only use a landline, then many of these vulnerabilities may be irrelevant. 

Stage 2

The next step—and likely the most important step in this process—is to review and be aware of potential cultural and generational differences relating to the dilemma. A behavior or practice that could be completely ethical in one setting could be discriminatory in another setting. 

For example, having a policy that you do not text clients will likely be okay for most clients; however, what if you have a client who is deaf for whom texting is his or her primary mode of electronic communication? 
We need to be aware of both cultural and generational differences that exist between the clinical mental health counselors and our clients. 

Stage 3

Next, counselors need to clarify their personal thoughts and feelings regarding their digital vulnerability. What are your preferences, limits, etc.? 

Internet Searches—
Can They Ever Be a Two-Way Street?

Searching the Internet is a common way for individuals to seek counseling services. In addition, clients research their counselors online to see reviews or to find out more information about their counselor. But be aware that the information clients are looking for about their counselors is not only professional—clients search online to find out personal information about their counselors as well.

Knowing that clients will search online for information about their counselors, is it ethical for clinical mental health counselors to look online for additional information about their clients?

The first time I encountered this dilemma was when a counselor I worked with discovered destructive information about a client. Through an Internet search, the counselor discovered that the client had a history of litigation against past healthcare providers, including mental health professionals.

The counselor faced a series of ethical dilemmas at that point, including: Should the counselor tell the client about the information the counselor found? How will that information affect the counseling process? How will it affect the counseling relationship? Will the counselor be more reserved in the counseling process due to fear of legal actions?

Working with the counselor, we used an ethical decision-making model to resolve the dilemma and created guidelines to protect the counselor from similar future dilemmas including:
  • Have a clearly articulated rationale for searching online for information about
    a client.
  • Inform clients about the use of search engines to gather client information.
  • Understand that discussing Internet searches of a client will likely affect the therapeutic relationship.
  • Be prepared to talk with clients, if you deem it appropriate, about your rationale for searching online for information about them.
There have been three types of adopters of technology in counseling:
  • The enthusiastic adopters. These people tend to push the limits of how technology is being integrated into their counseling practices. This group uses technology far beyond what the codes of ethics have identified and described.
  • Those who reluctantly adopt the use of technology. Only after they see the costs and benefits of technology from the first group of tech adopters will they begin to adopt it into their own counseling practice.
  • The technology avoiders. Even when the use of a technology is common practice, these individuals will still avoid using the technology.
  • It’s important that each counselor define for themselves their comfort level with a specific technology and its use in their practice.  
Stage 4

Once mental health counselors have defined personal preferences for the use of technology and have an understanding of the specific technology they want to use in their counseling practice, the next step is to review relevant ethical and professional standards as well as review relevant literature, company policies, and procedures. Counselors need to be familiar with the position of their professional organization on the topic. For example:
  • AMHCA’s 2010 Code of Ethics provides specific guidance on the use of technology in counseling practice.
  • In addition, AMHCA has issued a series of white papers, one of which addresses distance counseling.
  • The American Counseling Association’s 2014 Code of Ethics now has a section dedicated to digital ethics.
These are three excellent resources that clinical mental health counselors should refer to in order to help guide them in their ethical practice. 

Once CMHCs are familiar with their personal preferences, generational and cultural differences in the use of technology, and relevant professional standards, it’s important to articulate and document the rationale for their position on each instance of their digital vulnerability. 

For example, if you are going to use a cell phone or smartphone to text clients, why or why not, and what is the rationale for your decision? How will you use the Internet, how will you handle friend requests? By this point, you should have developed a specific set of standards for your practice or agency based on the best available literature. Thus, when ethical dilemmas arise, you will have a clear rationale to justify your decision, policy, or practice. 

Stages 5 and 6
The last two stages in this process come from a risk-management perspective:
  • Be sure to identify and implement mitigation and prevention strategies, and finally,
  • Consult with colleagues, lawyers, or experts in the field about the behaviors, policies, and practices that have been developed to protect counselors and their clients.
 
Ethical Dilemmas Won’t Go Away, But They’ll Be Easier to Manage

This process will not insulate clinical mental health counselors from ethical vulnerabilities; however, it will allow them to be proactive and empowered instead of reactive in managing digital risk. Also, when a dilemma arises, CMHCs will have an informed rationale in place that can justify their clinical behaviors. 

The counseling profession is a very dynamic and creative field, with few one-size-fits-all solutions to the digital dilemmas that counselors will encounter. What is ethical in one situation may be unethical in a different setting or with a different client. As a result, clinical mental health counselors need to be open-minded to the different ways other CMHCs will chose to use technology in their practices, while doing their part to ensure they are providing ethical and effective counseling to their clients. 

Steven DeMille, LCMHC, is a licensed mental health counselor in Utah. He is a Mellivora Group partner and provides consultation and advanced training on digital ethics. In his clinical work, he works with adolescents in an Outdoor Behavioral Healthcare program and is the research director for the program. You may reach him by email at smdemille@gmail.com.

 

American Mental Health Counselors Association

675 North Washington Street, Suite 470 Alexandria, VA 22314
Phone: 800-326-2642 or 703-548-6002 Fax: 703-548-4775

 

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