NOTE:Using the American Association for Marriage and Family Therapy Code of Ethics please respond, using APA format, in a 2-3 page paper, to the following ethical dilemma from the text: You will need

NOTE:Using the American Association for Marriage and Family Therapy Code of Ethics please respond, using APA format, in a 2-3 page paper, to the following ethical dilemma from the text: You will need
Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 1 Origins and Growth of Family Therapy • Historical Roots of Family Therapy • Schizophrenia • Fromm -Reichmann (Schizophrenogenic Mother) • Bateson and the double bind • Lidz: Marital skew and marital schism • Bowen, Wynne and NIMH studies • Pseudomutuality and pseudohostility • Marriage and premarriage counseling • Child guidance movement Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 2 Origins and Growth of Family Therapy • Group Dynamics and Group Therapy • The Evolution of Family Therapy • From research to treatment • The rush to practice • Innovative techniques and self -examination • Professionalization of the field • Multiculturalism and a new epistemology • Medical family therapy Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 3 Origins and Growth of Family Therapy • Integration, Eclecticism, and the Impact of Social Constructionism • Managed Care • Ecological Context • Multisystemic Interventions • Core Competency Movement • Evidence -Based Practice Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 4 Professional Issues and Ethical Practices Professional Issues • Licensing and certification • Continuing education • Peer review (clinical work and professional writing) Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 5 Professional Issues and Ethical Practices Ethical Practice • Confidentiality/Privileged communication • Legal liability • Malpractice • Informed Consent • Code of ethics (see next slide) • Ethical Issues specific to treating couples and families • Mandated reporting • Maintaining professional competence Professional Issues and Ethical Practices AAMFT Code of Ethics • Responsibility to clients • Confidentiality • Professional competence and integrity • Responsibility to students and supervisees • Responsibility to research participants • Responsibility to the profession • Financial arrangements • Advertising Goldenberg/Goldenberg, Family Therapy, 8th edition © Brooks/Cole Cengage 2013 6
NOTE:Using the American Association for Marriage and Family Therapy Code of Ethics please respond, using APA format, in a 2-3 page paper, to the following ethical dilemma from the text: You will need
The Evolution of Family Therapy and Current Ethical Practices Imagine what the world of Counseling would be like without the integration of family therapy.  This week’s lecture will cover the historical growth and development of family therapy.  We will take a journey into the milestones that have contributed to the evolution of the field.  You will also explore landmark research studies that contributed to the process of validating the need for family therapy.  You will be challenged to consider some of the ethical dilemmas that family therapists are faced with.  This week’s lecture will cover chapters 5 and 6 of the text.  You will also be asked to review the AAMFT Code of Ethics.  Lastly, you will read a journal article on ethical issues faced by family counselors.  Your assignments will consist of responding to three discussion questions, along with an ethical dilemma.  Don’t forget your two peer responses, as well as to properly integrate and cite the readings in your work, and include a reference list. Learning Objectives By the end of this week, you will : Recognize the historical growth and development of family therapy. Demonstrate an understanding of ethical and professional standards of practice as applied in family therapy. Apply professional standards of practice to address ethical dilemmas.    Readings Please read the following for this week as well as All Week 3 Online Course Materials: Goldenberg, H., & Goldenberg, I. (2013): Chapters 5 and 6 Jordan, N. A., Russell, L., Afousi, E., Chemel, T., McVicker, M., Robertson, J., & Winek, J.(2014). The ethical use of social media in marriage and family therapy: Recommendations and future directions. The Family Journal, 22(1), 105-112. doi:10.1177/1066480713505064 Week 3: Lecture The History of Family Therapy The evolution of the field of family therapy has many twists and turns, some might argue, beginning with the concept of systems theory and dating back as far as World War II, as families reunited after the war.  Research on schizophrenia proved to be groundbreaking as it relates to family therapy, because it provided a starting point for the examination of family communication patterns.  The idea of marital and premarital counseling emerged as an avenue permitting couples to resolve conflicts together, as opposed to separately.  Similarly, the child guidance movement focused on treating the entire family.  Lastly, group dynamics were adopted as models of family functioning. It is worth noting that during the evolution of family therapy, therapists were challenged to examine their values and attitudes for the purpose of addressing sexist views that could possibly interfere with effectively working with all family members.  As counselors-in-training, it is important to understand that this is a process which is truly never complete.  You should be evaluating and addressing your own biases on a regular basis so that you are able to provide the most professional therapeutic interventions for your families. The field of family therapy continued to evolve in a way that permitted family therapists to borrow different techniques and concepts from one perspective, while maintaining their own view of the family unit. Currently, family therapy is moving beyond exploring family relationships to considering the social systems in which families exist.  This equips family therapists with a deeper understanding of the family’s experience as they relate to gender, ethnicity, race, class, and sexual orientation.  The field of family therapy is also moving to an emphasis on evidence-based practices for the overall goal of providing both quality and cost-effective interventions.  The core competency movement seeks to find a solution for integrating differing views into a solid professional identity.  Competencies in the family therapy field also provide a standard of care by which counselors can work to ensure consistency in practice; which ultimately sends a message to managed care organizations about the level of service that therapists are required to provide.  This is just an example of one of the many professional issues that counselors must be prepared to face within the helping profession.  Week 3: Lecture Professional Issues in the Field When we think of professional issues in the field, we automatically think of an ethical dilemma, which can be frightening.  This is why the ultimate goal of this segment is to explore some commonplace issues in the field and ways to best avoid them.  Addressing professional issues in the field of family counseling is especially important for ensuring that counselors are aware of the most current ethical standards and can therefore deliver the highest quality of care to the clients who are served by them.  Family therapists have an ethical responsibility to the field that extends even beyond their work with clients to their formal writing.  Therapists must be able to demonstrate, in formal writing, their ability to accurately cite reference sources, which is why this is currently stressed in your graduate level work; in an attempt to prepare you for this process as you enter the field. As you enter the field of counseling, you may also find yourself in the dilemma of having to balance financial considerations with clinical needs.  It is important now to begin thinking about what this balancing act would be like, or if it is truly possible to find a balance.  This is a time in which your values and beliefs may also come into play.  It is important to remember that your first obligation rests with maintaining your integrity as a family therapist by doing what is deemed most ethical for the client.  This may also involve seeking consultation and heavy documentation of the sequence of events that have evolved, in order to avoid legal ramifications.    There are many types of malpractice suits, spanning from failure to obtain informed consent to abandonment of a client.  Ways of avoiding a malpractice suit can be fairly easy and begins with accurate documentation and record keeping, to include updated treatment plans and case notes, ensuring that you are protecting the family’s confidentiality at all times, making arrangements for clients to be seen if you are not available, and making appropriate referrals.  Ensure that you understand your agency’s policies for getting more help for a suicidal or homicidal client.  Lastly, be sure to write your notes in a way that you would feel comfortable discussing their content if subpoenaed by a court of law.  Family therapists are cautioned about being upfront with clients about their willingness to appear in court, so that families have an opportunity to select a different counselor, should they so choose to do so.  It is important for counselors-in-trainings to begin thinking about how they might work with a family whose ethnic background might call upon practices that differ from what the ethical standards deem appropriate.  Similarly, as addressed in weeks one and two, family therapists are urged to monitor their own biases against families whose beliefs may not be consistent with their own. Many times families share secrets and it is important for family therapists to be upfront and honest with families about their position on this issue before services begin so that there are not any unpleasant surprises as the sessions progress.  Along these same lines, families should be notified of the limits of confidentiality so that they do not feel betrayed if the family therapist needs to disclose information in order to get them more help.  Clients will appreciate any counselor’s attempt to adhere to ethical standards when these standards are made transparent at the outset of therapy. Week 3: Lecture Ethical Standards Family therapists are governed by the American Association for Marriage and Family Therapy Code of Ethics.  Family therapists are required to have a working knowledge of these standards, to consult the standards on a regular basis, and to conduct their professional practices accordingly.  You are encouraged to review the AAMFT Code of Ethics in their entirety.  As you read the journal article for this week, think about how the Code of Ethics should be considered when exploring the use of social media in family therapy.  The first Principle of the Code of Ethics is Responsibility to clients, and this should be at the forefront of every family therapist’s mind, guiding their work with families. More information regarding me, my family & my background. My name is Yazmillie Fuentes and I was born in Aibonito, Puerto Rico and raised in a small town named Cayey. I lived with my mother, maternal grandmother, brother, cousins and aunt. Although my mother divorced my dad, her accomplishment in becoming a business woman became my inspiration. Juggling between furthering my career, my wonderful four children and grandson has been my pride. However, it has also been a challenge that I have been trying to overcome, In spite of that, I know that I have the drive and ambition to keep moving forward. Being determined and setting goals for my future has always been a part of my personal experience. The field of Psychology caught my attention when I was in high school and I had taken an elective class in the tenth grade. I instantly felt the passion and I knew that this would someday be my career. I had my first son when I was sixteen-years old, and my second when I was seventeen-years-old. I worked a full-time job while also attending college. With the help of my marvelous mother and cousin, I was able to complete my Bachelor’s Degree in Psychology. Within four years I received my Master’s degree in Counseling Psychology and in 2007, I graduated from the University of Turabo in Puerto Rico. I made the decision to move to Florida in 2007, to provide a better life for myself and my children. I prevailed through the hardships of the language barrier. I had to find a way to adjust with limited job openings during that time. I was able to find a job in a daycare facility as a teacher, where I discovered working with children and helping families were also my passion. Also, during this period I got married and had two more children. In 2010, I was given a wonderful opportunity to interview for a position as a case manager at The Centers. Excitedly, I was hired immediately. I was required to take a 3 month training to be certified as a case manager with the child welfare system. Working as a case manager for five years gave me the aspect of personal and professional growth. In addition, I acquired the experience in the court room. This personal growth has made a significant impact on my life. Learning how to help the parent alter their perspective with hopes of a change of heart was also a reward. These changes helped me with the ability to unite families and help them process through their conflict. Currently in my career, I have advanced into an Individual/Family Counselor position with the Arnette House, as well as an Independent Contracted Clinician with Families First of Florida as a Mental Health Counselor. At the Arnette House my responsibility is to visit with children in school settings in order to establish a connection with the child and provide counseling services. Within my counseling sessions, anger management, depression, bullying, social, and coping skills are addressed. I counsel individually and apply the therapeutic interventions of Solution Focused Therapy to implement solutions instead of focusing solely on the problem. I use a collaborative approach psychoeducation and Reality Therapy to help my clients learn how take ownership and responsibility for their actions. I also utilize Cognitive Behavior Therapy, Talk, Art, and Play Therapy. I believe group therapy is effective in certain cases, therefore it is an essential part of my treatment process because I work with groups in school settings. Appealing to their situation and listening is a significant part of the therapeutic process. At Families First of Florida, I have the opportunity to counsel children with autism, ADHD, and severe depression as well as other clinical diagnosis. Currently, it is my goal to provide parents with the skills and coping mechanisms for their children, so that both the child and parent receive the services they are needing. Through the years and with the experience that I have acquired in the field, I am proud to say that many of my dreams have been fulfilled. I have maintained many cases that has given me a sense of duty. I am also in the process of continuing studies to obtain a license as a mental health counselor. In the future I know that I would be interested in teaching college level students. I know this is also an evolving passion, because I believe students not only need to be taught “by the book” principles. However, they should also learn from the perception of personal experience and application. I know that I have the motivation and ambition to provide the future generation with my multi-cultural, innovative and passionate views. My ultimate goal is to open a family care facility that will provide services for children and families in need. The goal is to provide the parents with tools and resources to better their parenting and family conflict skills. I believe that when parents are equipped with skills, their children benefit. The goal of this counseling practice would be to unite families. I have multicultural views in which I am able to appeal to different situations concerning different lifestyles. I will provide counseling with passion and determination to resolve conflict; which is why I will succeed in everything I do. Ultimately, my goal is to work with children and families to assist them in getting to a place of healthy and stable functioning. This opportunity is a necessity for me to get into the position to advocate and mediate on the behalf of families. I know this is something I will be good and my contribution will be effective. I am very excited about this opportunity to further my education.
NOTE:Using the American Association for Marriage and Family Therapy Code of Ethics please respond, using APA format, in a 2-3 page paper, to the following ethical dilemma from the text: You will need
Ethics The Ethical Use of Social Media in Marriage and Family Therapy: Recommendations and Future Directions Nickolas A. Jordan 1, Lindy Russell 1, Elnaz Afousi 2, Tasha Chemel 2, Melissa McVicker 2, Janet Robertson 2, and John Winek 1 Abstract Increasingly, people spend time online, communicating via e-mail, websites, instant messages, and various social media platforms that incorporate text, video, and online photo albums. Social media have altered the way people spend their time and commu- nicate with each other; this includes mental health professionals. It is imperative that therapists are knowledgeable about the ways social media affects clients’ personal interactions as well as the ethical implications of their own professional use of social media. Professional organizations do not provide adequate ethical guidelines for therapeutic practice regarding social media; therefore, ethical codes should be adjusted to include the new media as they arise. After reviewing related literature from other mental health disciplines, the authors offer recommendations to be integrated into the professional ethical codes for mental health pro- fessionals to ensure the ethical use of social media in therapy. The authors organize their recommendations around several key principles from various mental health codes of ethics. Keywords ethics, marriage and family therapy, social media, online, confidentiality, professional competence, responsibility to clients Social media such as Facebook, Twitter, eHarmony, and MySpace have come to dominate popular culture. People have access to friends and family through social media virtually at all times. Whether at home on the desktop computer, in the library with a laptop, or on the go with a smart phone, friends, ‘‘fans,’’ and ‘‘followers’’ are never more than a few clicks away. For the purposes of this work, social media—sometimes referred to as social networks—are defined as Internet-based applications used in direct and indirect social interactions. Social media have become entrenched in how many people communicate with one another. It has even been argued that the order of relationship development has changed (Palfrey & Gas- ser, 2008). In the past, it would have been necessary to engage in some sort of conversation in order to find out if a potential partner had a pet or siblings, where he went to high school, and what his interests and life goals are. Today, a couple on a first date might come armed with the most insignificant and inti- mate details of each other’s lives without ever having had a conversation. Not only providing new ways for friends and family or romantic partners to connect, social media increasingly serve as a platform for professional communication. Seemingly no one is immune to the siren’s song of social media. For example, on the American Association for Marriage and Family Therapy (AAMFT) website, one can find Facebook, Twitter, and MySpace icons at the bottom of the page; the American Counseling Association (ACA) page links to several blogs and an official Twitter page. The ACA, American Psychological Association (APA), National Association of Social Workers (NASW), and International Association of Marriage and Fam- ily Counselors (IAMFC) all maintain active Facebook pages. In both the personal and the professional realm, social media are providing a new vehicle for self-promotion. In a capitalist society, there is nothing unusual about business self-promotion. But when it comes to mental health professionals, even those running a private business, such self-promotion creates a host of questions. Specific media hold their own ethical questions. Facebook, for example, allows pro- fessional pages—but to follow a therapist’s page, one must ‘‘like’’ the page, which creates a public record of each person who follows a therapist’s online presence. This in itself could 1Department of Human Development and Psychological Counseling, Appalachian State University, Boone, NC, USA 2Department of Applied Psychology, Antioch University New England, Keene, NH, USA Corresponding Author: Nickolas A. Jordan, Department of Human Development and Psychological Counseling, Appalachian State University, 151 College St., ASU Box 32075, Boone, NC 28608, USA. Email: [email protected] The Family Journal: Counseling and Therapy for Couples and Families 2014, Vol 22(1) 105-112 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066480713505064 tfj.sagepub.com at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from create a violation of confidentiality. Twitter’s 140-word character limit creates problems in relation to language and adequately communicating ideas. And while some ethical boundaries may be obvious, many are unclear across the realm of social media. In the supervision relationship, for example, one could ask if it is ethical for supervising therapists to use Skype in order to supervise over long distances; and if such supervision should be able to count toward licensure. Or in the case of a vacationing therapist, is it ethical to maintain client contact via computer-mediated text messaging (e.g., America Online Instant Messenger)? Are those service hours billable?Trust and confidentiality are both murky concepts when social media are involved—especially in the context of a pro- fessional therapeutic relationship. And while there is a plethora of research surrounding social media and its widespread effect on personal and romantic relationships, marketing, and per- sonal development, the authors found very few articles addres- sing social media in relation to therapeutic practice (Kaslow, Patterson, & Gottlieb, 2011; Zur, Williams, Lehavot, & Knapp, 2009). No definitive ethical guidelines seem to exist; and we found more questions than answers. In an almost universal fashion, the mental health field is silent on how to—or whether mental health professionals even should—use social media in therapy. Among the AAMFT, Commission on Accreditation for Marriage and Family Therapy Education, ACA, NASW, IAMFC, and APA, none provide officially recognized ethical standards for the use of social media in therapeutic practice. A serious problem arises: Therapists are using social media without any effort on the part of professional organizations to understand how social media are being used, to investigate and educate about the legality of such interventions, or to provide ethical guidance for practitioners who may not fully understand the possible implications of their actions (AAMFT, 2011; ACA, 2005; APA, 2010; Hendricks, Bradley, Southern, Oliver, & Birdsall, 2011; Workers, 2008). This work attempts to build an initial list of guidelines for family therapists, counselors, social workers, and psychologists to consider before integrating social media into therapeutic practice. First, we will review applicable literature describing the use of social media in mental health and the ways in which various mental health practitioners manage social media. Next we will provide recommendations for several key principles that could be adapted and amended to each professional group’s Code of Ethics. We do this in the hope that future mental health professionals are more likely to practice mindfully and ethically when incorporating social media into their practice. Finally, we will discuss implications for future directions in research regard- ing ethics and social media. Please note that for the purposes of this work, we use the terms therapist, psychologist, mental health professional, and practitioner interchangeably. Review of the Literature In the last two decades, the use of media technology has increased, leading to changes in how mental health professionals communicate with clients and each other (Negretti & Wieling, 2001). Social media platforms have transformed online communication and provide a new realm for many mental health professionals to provide services (Fitzgerald, Hunter, Hadjistavropoulos, & Koocher, 2010; Jencius & Sager, 2001). This review focuses specifically on work related to how mental health professionals and accredit- ing bodies use social media and electronic forms of communi- cation in therapeutic practice. The increase in the use of first electronic and then social media to provide information and enhance communication has encouraged new forms of mental health services to develop (Pollock, 2006). Many professionals have endorsed the use of electronic communication in practice as a way to provide care and services to underserved populations in a cost-effective way, as well as a way to facilitate supervisory, clinical, and educational opportunities (Rosik & Brown, 2001). Some use electronic discussion groups, chat, and videoconferencing to facilitate support groups or provide resources for mental health concerns (Guterman & Kirk, 1999; Pollock, 2006). In addition, e-mail, Facebook, and LinkedIn are often used to collaborate and consult with others in the field, to share articles and resources, and to plan meetings and workshops. Mental health professionals have increasingly offered online services to cli- ents (Guterman & Kirk, 1999), and with the growth of social media applications, this trend is likely to continue. The Internet has been used in the mental health field by the major national professional organizations to market their services, including the AAMFT (Guterman & Kirk, 1999), and some organizations have begun addressing the use of Internet- based services in practice. The ACA established standards for the use of online counseling and communication, and the American Mental Health Counselors Association revised its code of ethics in 2000 to include an online counseling section, acknowledging the considerations for the electronic transfer of client information, confidentiality, and counselor identification (Jencius & Sager, 2001). The IAMFC proposed revisions in 2001 to urge members to refrain from providing specific advice to individuals through the media and other public venues, with- out providing follow-ups or comprehensive assessments (Jen- cius & Sager, 2001). Unfortunately, no recent revisions have provided guidance in terms of appropriate uses for social media like Facebook, MySpace, Twitter, and YouTube. Professional organizations provide guidelines for appropri- ate practice through their ethical codes. Therefore, with com- munication technology continually advancing, there is a need for the accompanying legal standards and ethic codes to develop at a similar pace (Jencius & Sager, 2001; Rosik & Brown, 2001). Organizations should examine what services are being provided through social media use and assess the risk or liability in such practices (Rosik & Brown, 2001). In addition, to avoid ethical and boundary violations associated with using communication technology, mental health professionals should develop expertise and practice with social media technologies (Jencius & Sager, 2001). Therapists should hold up-to-date knowledge of the social media platforms themselves, as well 106 The Family Journal: Counseling and Therapy for Couples and Families 22(1) at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from as technical and ethical issues involved prior to and while employing them in a therapeutic context (Negretti & Wieling, 2001; Pollock, 2006). Currently, the AAMFT, NASW, ACA, and APA do not include specific information about the use of social media in their codes of ethics (AAMFT, 2011; ACA, 2005; APA, 2010; Workers, 2008). For this reason, we offer recommendations for mental health professionals to encourage mindful practice in the use of social media. We have selected general principles from the ACA, NASW, AAMFT, and APA’s Code of Ethics that are most representative of the issues raised by the use of social media in mental health. Whenever possible, case vignettes are used to illustrate some possible ethical dilemmas therapists may face. Ethical Considerations As mental health professionals, supervisors, educators, and students, we argue that the current state of ethics across disci- plines regarding the use of social media is insufficient. The IAMFC, the NASW, the ACA, and the APA offer no guidelines in the specific use of social media in therapeutic practice (ACA, 2005; APA, 2010; Hendricks et al., 2011; Workers, 2008). Even the most recent revisions of the AAMFT ethics code which address some potential issues that arise from computer-mediated family therapy fail to mention social media by name (AAMFT, 2011). We believe this to be a serious concern.We offer guidelines for the use of social media in mental health practice, applying them in conjunction with applicable state and federal laws. These guidelines are not intended as exhaustive or definitive considerations. Rather, the following guidelines provide overarching themes to consider and act as a beacon for mental health professionals to follow toward mindful use of social media. The authors do not claim to know whether using social media in mental health is, in fact, ethical at all; rather, we begin asking the difficult questions associated with the use of social media in therapeutic practice and encour- age readers to determine their own sense of where social media fit into their individual ethical practice and contribute their perspective to the larger professional conversation. Principle 1: Social Media in Therapy Mental health professionals are aware that social media in general blur boundaries (Palfrey & Glaser, 2008); therefore, mental health professionals consider how clients may perceive information through social media. The rules for communicating are different through social media than more traditional forms of expression (Zur & Zur, 2011). The odds of offense through miscommunication are already high; communication through social media only increases that probability. Contextual components of commu- nication such as tone and body language are often absent. Even the crafting of an appropriate ‘‘good-bye’’ in an e-mail could leave writers open to unintended consequences. Much the same way a hug, handshake, or wave signifies both a physical and an emotional relationship; the way one closes an e-mail—‘‘Best wishes,’’ ‘‘Sincerely,’’ ‘‘Kind regards,’’ ‘‘Warmly,’’ or ‘‘Affec- tionately’’—provides different connotations to the interaction, and can significantly impact relationship development between therapist and client. Professionals wishing to use social media in their practice must be descriptive, transparent, and aware of the social rules that govern communication. Principle 2: Responsibility to Clients Guideline 1.1: Informed Consent. To avoid misunderstandings and to ensure the boundaries of the therapeutic relationship are clear, mental health professionals inform clients of their policy on the use of social media in therapy, including possible risks and communication styles (sample informed consent, Appendix A). In order to adhere to the general informed consent guide- lines, mental health professionals should include a section within the document addressing social media. Such policies should contain information about whether or not a therapist will search for a client using social media sites or general web searches prior to or during sessions, as such a search could be considered an invasion of privacy; it is also recommended such searches be discussed with clients in session beforehand. To address client and therapist boundaries, policies should also describe whether and how the therapist would respond to a cli- ent on social networking sites should contact be initiated— intentionally or otherwise. If contact is anticipated, the mental health professional should communicate expected boundaries, including the type of information the therapist is comfortable sharing over social media and the therapist’s availability out- side of sessions. For example, a policy might explain that while a therapist will respond to client e-mails concerning the sche- duling of appointments, he or she will not discuss therapeutic issues over e-mail (Pollock, 2006). In addition, a professional might detail a no-contact policy for social networking sites, meaning he or she will not respond to clients’ requests to connect on such sites, nor will he or she initiate such requests. Finally, a professional might also specify he or she does not check e-mail over weekends and might take up to 24 hr to reply to an e-mail (Negretti & Wieling, 2001). If a mental health professional does choose to incorporate the use of social media into therapy, he or she should conserva- tively disclose possible risks to the client. For professionals who conduct sessions online, it is imperative the client under- stand the therapist will not be able to adequately respond to the client in an emergency, especially if the client and therapist are far away from each other. Therapists who are working with clients using only a written channel, such as e-mail or text chat, might also have difficulty assessing the client’s risk of endan- gering self or others because the therapist does not have access to nonverbal cues (Negretti & Wieling, 2001). To mitigate this concern, the client should be informed that the therapist requires a means of contacting him or her offline, as well as the name of at least one other person who can serve as an emer- gency contact. The therapist should also inform the client that Jordan et al. 107 at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from he or she will work with him or her to make a connection with a local treatment provider who will be able to respond promptly should an emergency occur (Pollock, 2006).Mental health professionals should also relay the possible risk of unintentional breach of confidentiality. Therapists communicating with clients over e-mail or social media should specify whether this communication is secure (encrypted) and should disclose the possibility of another party gaining access to the communication, including companies such as Skype and Facebook (Jencius & Sager, 2001). Practitioners should also inform clients about the risks of granting access to their pages on social networking sites for therapeutic purposes, such as the possibility that the therapist might gain access to information that the client did not intend to share. Clients should understand the therapists’ status as a mandated reporter (if self-harm or harm of another is anticipated, or if elder or child abuse is suspected) is still applicable to information obtained from social networking sites. Clients who choose to connect through their professional pages on social networking sites should be informed that there is a potential for third parties to identify them as clients. Finally, client expectations of the mental health professional should be discussed in session. Case vignette. A teenager, still a minor, allows her therapist to read her blog, since she finds it easier to express herself in writing. One of her blog entries mentions that she and her adult boyfriend are having sex. According to state law, the therapist is mandated to report this information, since the client is under- age, which constitutes neglect in the therapist’s state. However, the therapist’s informed consent document did not clarify that mandated reporting laws are applicable to online material. The teenager becomes angry and accuses the therapist of violating confidentiality. Guideline 1.2: Multiple Relationships. Mental health professionals and supervisors are aware of the impact their self-disclosure on social media sites may have on professional relationships. The use of social media in the professional relationship is negoti- ated as a part of the therapeutic contract. Educators who use social media in their instruction have a clear social media policy integrated into their syllabi. Professionals who include personal information and have contact with clients on social networking sites could likely be described as taking part in a dual relationship. Since personal information is exchanged, professional and personal bound- aries could be blurred, which could impair professional judg- ment or diminish credibility among clients and colleagues (Lehavot, Barnett, & Powers, 2010). For this reason, profes- sionals should seriously consider how these connections can impact their clients. While dual relationships are not inherently negative and healthy boundary crossing can be helpful for some clients; such relationships will not benefit all clients, and mental health workers should be very careful to avoid boundary violations that could negatively affect clients (Pope & Keith- Spiegel, 2008). Therapists should remain intentional about deciding to access clients’ personal information and how he or she chooses to use this information in session (Lehavot et al., 2010). The choice should not be made to access clients’ personal information unless the therapeutic benefits outweigh the risks and never simply to appease curiosity. Further, online searches for client information—perhaps with the aim of veri- fying a client’s statement—could damage the therapeutic rela- tionship if it is not done in the context of informed consent and collaborative therapeutic work. Guideline 1.3: Confidentiality. To ensure ethical violations are avoided, mental health professionals take additional care when utilizing social media in their practice. Mental health profes- sionals protect client privacy by using encryption software when possible and by discussing any risk of confidentiality breach. Total confidentiality while utilizing e-mail or social net- working site correspondence is almost impossible (Rosik & Brown, 2001). In addition to disclosing risks to confidentiality, there are measures that mental health workers can take to better protect their clients’ privacy. E-mail hosts should employ encryption software to maintain sole access by the client and mental health professional (Jencius & Sager, 2001; Rosik & Brown, 2001). For example, encryption software allows access by the two parties by granting both parties with an encryption key to access the e-mails (Jencius & Sager, 2001). It is up to the therapist to explain to the client the importance of protecting the key. This will prevent access by hackers and those who may intercept the e-mails during transmission over the Internet (Rosik & Brown, 2001). Mental health workers should also use a digital signature to ensure authenticity when sending e-mails. Some universities and institutions may have the rights to access employees’ e- mails. This may be unavoidable in some circumstances, so cli- ents should be informed of the risks involved. E-mails should include a disclaimer stating the confidentiality of the e-mail and the recipient’s privacy rights. Access to the client’s com- puter and network should be discussed, as e-mail correspon- dences may be accessible by others. This should be an explicit conversation with couples and families because e-mails may be accessible by all members of the household. Secure networks and password-protected screen savers should be used at all times (Rosik & Brown, 2001). Appropriate dispo- sal of e-mails must also be implemented because of the perma- nency of the Internet. The California Association of Marriage and Family Therapy has already included an ethical guideline concerning therapy by electronic means whereby marriage and family therapists must inform the clients of the issues of confi- dentiality. Due to the limited nature of privacy over the Inter- net, mental health practitioners should be transparent in explaining all of the risks involved. The use of social media sites and online group formats may bring up additional confidentiality issues. Practitioners should be aware of information that may be accessed on their own sites that could lead to the identification of clients. Practitioners should explain the confidentiality risks to their clients if they are interacting in online group formats, as identities may be 108 The Family Journal: Counseling and Therapy for Couples and Families 22(1) at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from revealed if accessibility is not properly understood. Because of the risk to confidentiality, we suggest therapists do no frame online group formats as therapy, but instead frame them as non- therapeutic or support groups; and billing options would change accordingly.At the time this work was written, the authors could find no practical solution for messaging except for through e-mail. Social media are inherently nonconfidential and unfortunately, there is no practical way to encrypt communication through social networking sites like Facebook, Twitter, MySpace, and so on. Case vignette. A social worker who works in a rural area returns home from a stressful day at work and posts the follow- ing as her Facebook status: ‘‘Just got yelled at by my client with six children for inquiring about her thoughts on birth control. I hate my job.’’ One of her friends on Facebook is aware that a friend of hers is currently in therapy and has six children. She then asks her friend whether the social worker is indeed her therapist, which her friend then confirms. She tells her friend about the status post. The client’s trust and confidentiality has been violated and the therapeutic relationship remains dam- aged. The client then seeks out a new therapist but remains scarred by the violation of trust. Guideline 1.4: Professional Competence and Integrity. Mental health professionals receive training on the appropriate and ethical use of social media in therapy, as well as how social media impact individuals, couples, and families. Further, pro- fessionals assist clients in developing their own competence in the safe/healthy use of social media. As it is clear that social media and other web-based commu- nications will increasingly affect therapeutic relationships in one way or another, it is imperative for graduate programs to include curriculum regarding online communication and social networking in order to educate mental health workers on ethi- cal issues related to the Internet. Graduate programs are advised to include a focus on social media and associated ethics within the discussion. Additionally, practitioners should seek out continuing education opportunities to enhance understand- ing of social media interaction and to maintain standards of professional competence. Guideline 1.5: Responsibility to Students and Supervisees. Training supervisors and their supervisees are aware of the impact their self-disclosure on social media sites have on professional relationships. The use of clinical supervision via the Internet has been widely successful, and given the delicate topics and issues that arise in training for supervisees, a set of guidelines that includes the sphere of social media and the web would be beneficial to trainees and clients that are in their care as well (Fenichel, 2002). As in daily life, online interactions between supervisors and supervisees—or students and professors—are not inherently problematic. However, supervisors and educators should be mindful of how they present themselves online and the tone in which they interact with those under their care. In most cases, adding a student or supervisee as a Facebook friend should be avoided because of the risk of a potentially harmful dual relationship. The unintended exposure of personal infor- mation by either party could damage the relationship. Supervi- sors should have conversations in supervision about the agreed upon guidelines concerning supervision (Lehavot et al., 2010). Additionally, as many students may be more informed about the evolving technology, supervisors will need to educate themselves about the current social media sites and their use among students (Lehavot et al., 2010). Videoconferencing in supervision is another area of ethical concern. While using videoconferencing software in remote areas, supervisors should take additional steps to ensure pri- vacy. Supervisees need to consider whether anyone else could potentially hear the conversation and take the necessary steps to protect the clients’ confidentiality. There is also the risk of third-party involvement, as the video may be stored on the site’s database (Skype, for example, is completely nonsecured). This should be taken into consideration by using either initials or first names of the clients until security can be guaranteed. Case vignette. A supervisor posts his involvement in a rally against troops in Iraq on Facebook. A supervisee whose father is stationed in Iraq and supports the war is offended by the posts. The supervisor’s personal agenda has now leaked into the professional relationship and may affect his impact on the supervisee involved. Guideline 1.6: Responsibility to Research Participants. Mental health professionals set up appropriate safeguards when recruiting participants through social media sites. Further, mental health researchers take all necessary precautions when protecting the confidentiality of the participants. To minimize the risks, researchers should be selective in their choice of sites used to collect the data. If the participants are to remain anonymous, the IP (Internet Protocol address; this number is assigned to a specific computer on the Internet. This number contains the location information of that computer) addresses should be hidden from the researchers. Informed consent should be explained in a way that participants under- stand all the risks involved. When using social media sites, researchers should be aware that friending participants on sites such as Facebook constitutes a risk in the development of a dual relationship. Conclusion and Future Directions The seven guidelines set forth here are meant to assist mental health professionals in evaluating and monitoring their own use of social media (Appendix B). Hopefully, the major mental health professional organizations will make formal recommen- dations soon. Until then, it is the onus of individual practi- tioners to wrestle with the ethical implications of their social Jordan et al. 109 at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from media involvement. Practitioners who choose to utilize social media are encouraged to receive ongoing supervision and con- sultation in how to do so ethically and effectively in their prac- tice. For example, the AAMFT has an excellent ‘‘phone a professional friend’’ program for these types of issues as well as formal ethical consult procedures.While mental health services continue to expand to include or consider media use in practice, mental health organizations should address these uses in the standards for their field. These ethical guidelines could lay the groundwork for the revision of the ethical codes for various professional organizations. Given the nature of rapid change in social media and communication technology, ethi- cal considerations should be reviewed and modified regularly. Mental health professionals should become familiar with media platforms and evaluate them for possible ethical issues prior to using them in a therapeutic context. As technology advances and is integrated into professional practice in the men- tal health field, it is important for practitioners to stay informed of the changes and possible impact on practice and training needs. Furthermore, it is appropriate to explore the benefits of Internet use and technology and to be aware of applicable ethical standards. Mental health professionals are encouraged to educate themselves about the dangers and benefits of social media in order to help clients make better choices in using them. We also recommend that practitioners explore ethical practices regard- ing the use of social media and that therapists provide input to professional organizations to assist in the creation of appropri- ate ethical guidelines. Appendix A Informed Consent Example/Therapist Does NOT Use Social Media I have an e-mail associated with my position at the University. You should assume that this e-mail is not secure; please do not contact me by e-mail. Call me at XXX XXX XXX should you need to discuss scheduling issues. In order to preserve your confidence, I will not respond to e-mails sent by clients to my university account. I do not accept clients as contacts on any social media plat- forms. I will not respond to any communication other than phone or in-person contact. I will not attempt to find any infor- mation you put online nor will I read anything you may send via e-mail or social media platform. Informed Consent Example/Therapist DOES use social media I use e-mail for scheduling and occasional between-session contact. I will respond to e-mails within 1–7 days. Do not use e-mail to contact me about urgent matters. If you have an emer- gency, you should use the contacts described below (under Your Responsibilities). If you would like to schedule an appointment with me more than 1 week in advance, you will need to call me at XXX XXX XXXX. My e-mail account is secure and encrypted. However, while my e-mail is secure, yours may not be. You should be aware that third parties, including your e-mail or Internet provider, may have access to e-mails you send, meaning they are not confidential. Also, be mindful of who else may have access to your e-mail if you have a shared computer, shared e-mail account, or may leave your e-mail account open on an unattended computer. I use a professional Facebook page for the purposes of advertising my services, connecting with colleagues, and inter- acting with community agencies and professional organiza- tions. I do not offer online therapy. If you post a message on my Facebook page, or send me a personal message or e-mail, I will not respond online. Instead, I will discuss such contact with you in person at our next session. Further, you should be aware that if you ‘‘Like’’ my page, others will be able to see this connection and may make assumptions about our relation- ship, or may ask you directly about what our relationship is. If you make a public statement about your relationship with me, I will not be able to confirm or deny that relationship due to con- fidentiality issues. I also have a professional LinkedIn page in order to con- nect with colleagues and professional organizations. I do not accept clients as connections on my LinkedIn profile; if you try to add me as a connection, I will ignore that request. I have this policy for two main reasons. First, I believe there is a need for healthy boundaries regarding my personal and professional life, and while LinkedIn is a professional web- site, there is a blurring personal and professional exchange which I would like to avoid. Second, in order to avoid com- promising your confidentiality, I do not publicly link myself to my clients in any way. In addition, I do have a personal Facebook profile; however, I do not accept friend requests from clients. If you do find my personal profile and attempt to contact me, I will not respond to any information I receive from you. If we have mutual friends and happen to view each other’s information, we can discuss possible implications and how we prefer to proceed at our next session. Be aware that any information you post on social media, including Facebook or LinkedIn—even in a personal mes- sage—is not confidential, and is considered part of a public forum. This means anyone can legally access and share any- thing you post on these forums. Further, as in a therapy session, I am required by law to report anything I learn that leads me to believe that you are a danger to yourself or others; a child is being abused or neglected; or an elderly person is being abused or neglected. 110 The Family Journal: Counseling and Therapy for Couples and Families 22(1) at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from Appendix B Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, author- ship, and/or publication of this article. References American Association for Marriage and Family Therapy. (2011, July 1).AAMFT code of ethics . Retrieved from http://www.aamft.org/ imis15/content/legal_ethics/code_of_ethics.aspx American Counseling Association. (2005). ACA code of ethics. Alex- andria, VA: Author. American Psychological Association. (2010, June 1). Ethical princi- ples of psychologists and code of conduct. Retrieved from http:// www.apa.org/ethics/code/index.aspx Fenichel, M. (2002). Myths and realities of online clinical work. Cyberpsychology & Behavior ,5, 481–497. doi:10.1089/ 109493102761022904 Fitzgerald, T., Hunter, P. V., Hadjistavropoulos, T., & Koocher, G. P. (2010). Ethical and legal considerations for internet-based psy- chotherapy. Cognitive Behaviour Therapy ,39 , 173–187. doi:10. 1080/16506071003636046 Guterman, J. R., & Kirk, M. A. (1999). Mental health counselors and the internet. Journal of Mental Health Counseling ,21 , 309–323. Hendricks, B. E., Bradley, L. J., Southern, S., Oliver, M., & Birdsall, B. (2011). Ethical code for the International Association of Mar- riage and Family Counselors. The Family Journal,19 , 217–224. doi:10.1177/1066480711400814 Jencius, M., & Sager, D. E. (2001). The practice of marriage and fam- ily counseling in cyberspace. The Family Journal,9 , 295–301. doi: 10.1177/1066480701093009 Kaslow, F. W., Patterson, T., & Gottlieb, M. (2011). Ethical dilemmas in psychologists accessing internet data: Is it justified? Profes- sional Psychology: Research and Practice ,42 , 105–112. doi:10. 1037/a0022002 Lehavot, K., Barnett, J. E., & Powers, D. (2010). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice ,41 , 160–166. doi:10.1037/a0018709 Negretti, M. A., & Wieling, E. (2001). The use of communication technology in private practice: Ethical implications and boundary dilemmas in therapy. Contemporary Family Therapy: An International Journal ,23, 275–293. doi:10.1023/A:10111 78915547 Palfrey, J., & Gasser, U. (2008). Born digital: Understanding the first generation of digital natives . New York, NY: Perseus Books Group. Pollock, S. L. (2006). Internet counseling and its feasibility for mar- riage and family counseling. The Family Journal,14 , 65–70. doi: 10.1177/1066480705282057 Pope, K. S., & Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy: Making decisions, bypassing blun- ders, and mending fences. Journal of Clinical Psychology ,64 , 638–652. doi:10.1002/jclp.20477 Rosik, C. H., & Brown, R. K. (2001). Professional use of the internet: Legal and ethical issues in a member care environment. Journal of Psychology and Theology ,29 , 106–120. Workers, N. A. (2008). NASW code of ethics. Washington, DC: NASW. Principle I: Social Media Mental health professionals are aware that social media in general blur boundaries (Palfrey & Glaser, 2008); therefore, mental health professionals consider how clients may perceive information through social media. 1.1: Informed consent. To avoid misunderstandings and to ensure the boundaries of the therapeutic relationship are clear, mental health professionals inform clients of their policy on the use of social media in therapy, including possible risks and communication styles (sample informed consent, Appendix A). 1.2: Multiple relationships. Mental health professionals and supervisors are aware of the impact their self-disclosure on social media sites may have on professional relationships. The use of social media in the professional relationship is negotiated as a part of the therapeutic contract. Educators who use social media in their instruction have a clear social media policy integrated into their syllabi. 1.3: Confidentiality. To ensure ethical violations are avoided, mental health professionals take additional care when utilizing social media in their practice. Mental health professionals protect client privacy by using encryption software when possible and by discussing any risk of confidentiality breach. 1.4: Professional competence and integrity. Mental health professionals receive training on the appropriate and ethical use of social media in therapy, as well as how social media impact individuals, couples, and families. Further, mental health professionals assist clients in developing their own competence in the safe/healthy use of social media. 1.5: Responsibility to students and supervisees. Training supervisors and their supervisees are aware of the impact their self-disclosure on socia l media sites have on professional relationships. 1.6: Responsibility to research participants. Mental health professionals set up appropriate safeguards when recruiting participants through social media sites. Further, mental health researchers take all n ecessary precautions when protecting the confidentiality of the participants. Jordan et al. 111 at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from Zur, O., Williams, M. H., Lehavot, K., & Knapp, S. (2009). Psy-chotherapist self-disclosure and transparency in the Internet age. Professional Psychology: Research and Practice ,40 , 23–30. doi: 10.1037/a0014745 Zur, O., & Zur, A. (2011). The Facebook dilemma: To accept or not to accept? Responding to clients’ ‘‘friend requests’’ on psychothera- pists’ social networking sites. Independent Practitioner, p. 31. Retrieved from http://www.zurinstitute.com/facebook_therapy.pdf 112 The Family Journal: Counseling and Therapy for Couples and Families 22(1) at WEBSTER UNIV on March 16, 2015 tfj.sagepub.com Downloaded from