Counseling Today, Ethics Update

Ethical use of technology in counseling

David Kaplan December 9, 2006

Counseling Today is publishing a monthly column focusing on new aspects of the revised ACA Code of Ethics (the entire ethics code as well as previous “Ethics Update” columns are available on the American Counseling Association website at www.counseling.org/ethics).

ACA Chief Professional Officer David Kaplan conducted the following interview with ACA Ethics Revision Task Force members John Bloom and Christine Moll.

David Kaplan: Today we are talking about Standard A.12. of the revised ACA Code of Ethics: “Technology Applications.” When you compare the small section on computer technology in the 1995 code with the revamped and substantially expanded section on technology applications in the revised code, it seems like the comparison between an old Radio Shack Tandy TRS-80, complete with amber or green screen, and a current Dell XPS dual core processor.

John Bloom: The Ethics Revision Task Force got away from the 1995 emphasis on computer applications and expanded the section to include all technology, including the often overlooked application of telephone counseling, which actually predated computer counseling by decades.

Christine Moll: We have come a long way since those years. And we know that unknown technologies will emerge before the code needs to be revised again in 2015. As such, we tried to anticipate additional applications and issues that will occur within the next 10 years before the next code is written.

DK: That explains why the old code had less than one-half of a column devoted to technology, while the revised code has what is now the largest single section in the ACA Code of Ethics, measuring in at a whopping two and one-quarter columns.

JB: In 1995 we were dealing with this unknown entity called the Internet. We weren’t sure about its capabilities or shortfalls because at that time there was little or no research to document the effectiveness of computer-based counseling. As such, the previous standards were written almost out of fear and ignorance of the unknown and so emphasized what not to do. Now, 10 years later, we are starting to build a body of research which suggests technology-assisted counseling can be effective, and so we were able to build positive and proactive statements about how to proceed with technology. So one of the reasons that the section is greatly expanded is that counseling can now embrace technology rather than fear it.

DK: In 1999, under the leadership of President Donna Ford, ACA promulgated Ethical Standards for Internet Online Counseling. Is that document still in force?

JB: No. The current code of ethics incorporated and updated all previous ACA documents on ethics. 

DK: As previously mentioned, the expanded section on technology takes up over two full columns in the revised Code of Ethics. Let me present a fantasy scenario to you: If you and the Code of Ethics were on a sinking ship and you only had enough time to save three of the many new statements in Standard A.12. about technology applications in counseling before the ship went under water, which three would you save and why?

CM: I would first save Standard A.12.e., “Laws and Statutes.” Technology-assisted counseling, whether conducted by telephone, Internet, e-mail or other application, often results in the crossing of jurisdictional lines. So laws which apply in Texas may not apply in New York. It is incumbent upon a counselor to know and be in compliance with all laws in both their state or jurisdiction and the state or jurisdiction of the client.

DK: Is there a specific example that comes to mind?

JB: The states of Washington and Colorado have idiosyncratic disclosure laws that counselors need to know about when they provide technology-assisted counseling to any resident of those two states. The cybercounselor should be aware that most legal authorities believe that counseling takes place where the client is. So if you accept a client from outside your own state, it would be wise to check with the licensing board in that state for the rules and regulations with which you must comply and to determine if you must be licensed in the state in which the client resides.

DK: To help our members do this, a complete list of counselor licensing board websites is currently available on the ACA website at www.counseling.org/Counselors/LicensureAndCert.aspx.

JB: My first priority for rescue from the sinking ship would be the section dealing with informed consent (A.12.g.). If we are conscientious about being ethical, we need to do a good job of clearly defining for clients the pros and cons and the limitations and successes of the use of technology. Also, counselors often fail to realize that when they provide services utilizing technology that they are not just talking about potential clientele from across the hall or across the city, but across the nation and across the world. It is easy to neglect language differences, cultural differences and time zone differences that come with having the world at your cyberdoorstep.

DK: In our sinking ship scenario, what third new ethical statement revolving around technology would you rescue?

JB: One I find that a lot of people haven’t thought about yet is A.12.d. (“Access”), which focuses on accessibility issues. Oftentimes when counselors have thoughts about accessibility, the focus is on the important need for lower income families to have access to computers and other technology. But there is another critical arena that needs to be considered: the need for clients, students or supervisees with a disability to utilize our technology-related services. For example, individuals who have a visual disability may not be able to distinguish colors on a screen or even see the screen at all.

DK: Does the issue of technology accessibility for those with a disability include compliance with the Americans with Disabilities Act?

CM & JB: (Simultaneously) Absolutely!

CM: ADA requires that counselors, counselor educators and supervisors provide reasonable accommodations so that a client, student or supervisee with a disability can see the computer screen, use the keyboard, utilize dropdown and other types of menus and, in general, be able to access any of our services. The federal government’s website for complete information on ADA requirements is www.ada.gov.

JB: A great resource for determining the accessibility of an ACA member’s website or other website is Web Exact. The web address is Webxact.watchfire.com.

DK: The new technology subsection on World Wide Web sites (A.12.h.) has many important ethical imperatives, including the need to verify the identity of a cyberclient. Why is that important?

CM: For the purposes of confidentiality, it is important to know that the person you are communicating with at any given time is the same person with whom you obtained informed consent and with whom you established a counseling relationship. In other words, you need to know that the individual at the other end of the cybercounseling is your actual client and not a parent, partner, friend or hacker.

DK: A second reason for establishing client identity right from the start revolves around the issues of suicide and homicide. What if a client gives you an alias and then at some point tells you that they are going to kill themselves or someone else? If all you have is an alias and false contact information, the ambulance, police or other responsible party cannot respond to protect a life.

JB: A final reason for establishing client identity is that minors may seek counseling without their parents’ knowledge and therefore may pose as adults. It may be both an ethical and legal violation to provide services to a minor without parental permission, and the responsibility lies with the counselor to ensure that the client is old enough to give informed consent.

DK: How can you verify the identity of clients when you cannot see them?

JB: The counselor and client can create and exchange a confidential password at the beginning of a session.

CM: You can also set up a webcam with the client. Most computer stores can get you set up fairly inexpensively.

DK: The technology section in the ethics code talks about the need to use encrypted websites and e-mail communications whenever possible.

JB: We don’t want to break confidentiality by having a hacker break into our cybercounseling and communications with clients. Encryption is not as difficult as it sounds and is cost-effective.

DK: Do you have any resources or websites for counselors to learn how to encrypt?

JB: There is an excellent article titled “How Encryption Works” at www.howstuffworks.com/encryption.htm.

DK: Another new technology-related ethical imperative is that counselors must now strive to provide website translation capabilities for clients who have a different primary language. Are there any web resources to assist counselors in these efforts?

JB: I would encourage counselors to check out www.freetranslation.com.

DK: At this point our readers may be feeling that we have added more technology-related ethical imperatives than they can handle. How would you respond to a professional counselor who says, “This is overwhelming. I have a degree in counseling, not information technology. I can’t do all of this stuff.”

CM: The purpose of the new technology statements in the revised Code of Ethics was to inform, not to overwhelm.  Standard A.12. is meant to be educational, visionary and inspirational. It therefore outlines areas that professional counselors need to learn about if they choose to utilize technology in their direct services, teaching or supervision.

JB: There are many resources available to help educate counselors and counselor educators about incorporating technology into their practice, teaching and supervision. The newly revised ACA Ethical Standards Casebook by Barbara Herlihy and Gerald Corey (available at www.counseling.org/publications or 800.347.6647 ext. 222) gives helpful examples covering each of the points in Standard A.12. NBCC (National Board for Certified Counselors) provides a training program that leads to the credential of distance credentialed counselor (www.cce-global.org/credentials-offered/dccmain). Employee assistance programs are fast becoming experts in Internet counseling and can be excellent resources. 

DK: ACA has a number of resources available in addition to the ACA Ethical Standards Casebook. The second edition of Cybercounseling & Cyberlearning: Strategies & Resources (available at www.counseling.org/publications or 800.347.6647 ext. 222) and the online continuing education course “Cybercounseling: Going the Distance for Your Clients” (from www.counseling.org, click on “Resources” and then “Professional Development” for a list of courses) are both excellent guides for online counseling and distance learning. And of course, Larry Freeman, the ACA manager for Ethics and Professional Standards, provides personal attention to your specific needs and questions at lfreeman@counseling.org or 800.347.6647 ext. 314.

Next month: Obligations for protecting the confidentiality of the deceased

Letters to the editor: ct@counseling.org

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