Best Practices in Online Therapy

ABSTRACT

This article discusses important issues in delivery of best practice Internet-based therapy (etherapy). Etherapy is first defined as the interaction between a consumer and a therapist via the Internet (commonly via e-mail) in association with the use of a structured web-based clinical treatment program. A summary of the professional and ethical issues is provided, along with illustrated examples of best-practice principles experienced in clinical and research work by members of the Swinburne University of Technology Etherapy Unit (formerly the Etherapy Research, Education, and Training Unit in the Department of General Practice at Monash University). Etherapy has been found to be effective in treating a range of psychological disorders. Future research investigating methods of enhancing consumers' ability to engage in etherapy should further increase the effectiveness of this type of therapy.     

The LivePerson Model for Delivery of Etherapy Services: A Case Study

ABSTRACT

There are several models for the delivery of etherapy on the Internet. This article presents a case study of one model, the LivePerson website. The model is based on a privately owned infrastructure through which etherapy is practiced by licensed counselors using chat or e-mail for service delivery. A content analysis of the website is presented, including policies, number of consumers, consumer ratings, and therapists’ degrees, licensure, age, sex, race, fees, and languages offered. In addition, the experiences of one LivePerson practitioner are presented to highlight methods, processes, and ethical concerns. This case study of the LivePerson model for service delivery highlights many of the benefits and concerns previously discussed in the literature related to etherapy. In addition, concerns are raised that there may be some conflict of interest when ethical standards of practice are delivered within the context of a profit-making company.     

Evolving Ethical Standards in the Digital Age

ABSTRACT

Ethical standards in social work have matured significantly since the formal inauguration of the profession in the late 19th century. This article traces the global evolution of ethical standards in social work, focusing especially on current challenges in the digital age. The author discusses changes over time in social workers’ understanding of ethical issues and development of conceptual frameworks and protocols for managing them. Social workers’ increasing use of digital technology poses novel and unprecedented ethical challenges pertaining to privacy, confidentiality, informed consent, professional boundaries, conflicts of interest, documentation, client abandonment, and professionalism, among others. The article outlines emerging ethical standards designed to help social workers manage ethical challenges in the digital age.     

The curious case of case study: a viewpoint

Abstract

This paper focuses on microethical issues concerning interactions in which the process of informed consent occurs. It draws on research analysing the biographies and future hopes of 15- to 17-year-old girls and boys participating in targeted youth/educational programmes in the Helsinki area. The ethical challenge explored here is how to negotiate with the young interviewees on expanding the research setting towards a longitudinal and cross-generational approach, which also means expanding the data produced on their already well-reported lives. The paper highlights the power relations between adult researcher and young research participant, the contextual nature of gaining informed consent, and the conflict involved in trying to avoid hounding an over-surveilled group while still tracking their whereabouts and revisiting them for a follow-up interview.     

A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

ABSTRACT

Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.     

My Auto/Ethnographic Dilemma: Who Owns the Story?

This article explores ethical issues of co-mingled data, demarcating the field and informed consent in a study researching the consequences of Christian fundamentalist ideology on the lives of “Bible Belt gays”. When what constitutes informed consent is ambiguous, how does the qualitative researcher justify her decision either to include or exclude meaningful data? To illustrate these ethical issues, I analyze four instances of co-mingled data, two featuring Christian fundamentalists and two Bible Belt gays, in which I gain theoretical insights under conditions of blurry consent, and weigh potential harm to subjects against the liberatory goals of the project.     

An Ethical Assessment of Structured Intervention with Chemically Dependent Clients

ABSTRACT

Structured intervention is a widely accepted approach to helping the chemically dependent client get treatment. Because this method departs from the tradition of the client directly seeking help, it raises unique ethical diletnmas-for both client and practitioner-including issues of self-determination, secrecy, coercion, environmental manipulation, and “fair exchange.” Analysis of these issues using a model for ethical decision-making is followed by discussion of four ethical options for the practitioner. The authors identify a preferred emical position based on theoretical and practice knowledge plus professional and personal values.     

Enhancing Critical Thinking and Professionalism Through Use of the Discussion Forum in Social Work Practice Courses

SUMMARY

Development of critical thinking skills, application of theory, ethical decision-making, and achieving a professional identity are among the goals of social work education. This paper describes a three-year experience integrating discussion forums into graduate and undergraduate practice courses. Forums were designed to promote students' ability to use theory, analyze controversial issues, analyze and address ethical issues, professionally critique the work of peers, and conceptualize practice problems and issues for discussion in the forum. Evaluations indicated that discussion forums enhanced the depth of thinking about practice and practice issues and increased the sense of collegiality among students.     

Who Is a Jew?

Abstract

When a social worker incurs professional obligations in two different actions, but cannot do both, this is termed “an ethical conflict concerning expectations in concurrently affected arenas” (Levy, 1976, p. 113). This article addresses an ethical dilemma that is centered in one of the most complex and controversial issues within Jewish life today: the question of “who is a Jew.” A case is presented which depicts the complexity of ethical conflicts which may arise from this unanswered question. The values at issue are explored and the process used to clarify, legitimate, and operationalize a plan of action is articulated. Ethical dilemmas invariably arise in social work practice. Resolutions that are clear, easily applied, internally consistent, and that consider the values of all concerned should help in reaching an ethical solution.     

Social Media and Social Work: The Challenges of a New Ethical Space

ABSTRACT

Social media and other online technologies have transformed communication between social workers and service users, with many practitioners engaging and working with clients through social networking sites. While there are numerous ethical issues associated with online practice related to con?dentiality, dual relationships, and boundary crossing, there is lack of clarity about how to deal with such issues. This article uses a case example to develop a nuanced understanding of ethical issues and ethical behaviour in online spaces. We argue that social workers need to link their knowledge of the complex interplay between discourses that underpin daily practice like those related to power, permanency, authorship, audience, embodiment, and professionalism to social media created spaces. In doing this, social workers must retain their commitment to ethical values and critical reflective practice. We conclude with recommendations for education, research, and practice.     

Ethical Dilemmas of Practicing Social Workers Around Psychiatric Medication

Abstract

It is acknowledged that social workers in mental health and other settings routinely experience client-related ethical dilemmas. Further, there is wide recognition of the potential impact of ethical dilemmas on social work practice with clients who use psychotropic medication. Little is know empirically, however, about the experiences of practitioners with these dilemmas. This article describes the results of a national survey of practicing social workers regarding the nature of ethical dilemmas they face related to their work with clients on medication issues. The results make it clear that social workers regularly confront a variety of ethical dilemmas in this type of practice. Many of these dilemmas are related to ambiguities around the knowledge base of practice, appropriate roles of providers, and basic personal and professional values. The authors present implications of these findings for social work practice and further research.     

Boundary Issues in Gay and Lesbian Psychotherapy Relationships

Abstract

Gay and lesbian psychotherapists face unique challenges when working with clients who also identify as gay or lesbian. Of particular importance are the roles professional boundaries play in working with sexual minorities. For example, clinicians must decide whether it is in the client's best interests to know the therapist is gay. Issues of contact outside of the therapy hour also become important, particularly when the therapist lives in a small community, or otherwise risks the possibility of seeing the client in the community. This chapter addresses some of these issues, and poses options for therapists on how to minimize professional boundary or ethical violations.     

Working with Women Associated with Bikie Gangs: Practice Dilemmas

Abstract

Much has been written about bikie gangs, but there is little about the women and children who are part of gang life. The present paper describes domestic violence agency social workers’ ethical practice dilemmas when assisting women who have left bikie gangs to search for a new, safer lifestyle away from the gang culture of drug use and violence, in particular sexual violence. The paper concludes with a discussion of the ethical processes and issues in resolving such practice dilemmas.     

Conducting research using web-based questionnaires: Practical,methodological, and ethical considerations

The use of the internet for social science research is becoming increasingly common. This paper outlines practical, methodological and ethical issues for researchers to consider when using web-based questionnaires. This is illustrated by consideration of the authors' own experience of conducting a study into the phenomenon of self-harm.     

Exploring the Relationship Between Experiential Avoidance,Alcohol Use Disorders,and Alcohol-Related Problems Among First-Year College Students

Abstract

Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in their first year in college between December 2009 and April 2010. Methods: Participants completed a diagnostic interview and online self-report survey. Results: Students with a history of alcohol abuse or dependence had significantly higher levels of experiential avoidance relative to students with no alcohol use disorder diagnosis. A hierarchical linear regression analysis found that experiential avoidance significantly predicted alcohol-related problems, even after controlling for gender and psychological distress. Furthermore, experiential avoidance mediated the relationship of psychological distress to alcohol-related problems. Conclusions: These findings suggest that experiential avoidance may play a role in problematic alcohol use among college students.     

Morals,Ethics and practice — in search of social justice

Abstract

This paper reports a study of sources of influence on moral and ethical decision-making in social work practice. Practitioners from ten government and five non government agencies kept journals about the main moral issues they faced over a one-month period and were then interviewed about the nature of those issues, their resolution and the influences that shaped those resolutions. Practitioners' personal moral perspectives were found to be the main sources of influence on resolutions to a wide range of dilemmas and most of those resolutions did not conform to accepted social wok ethical practice principles. Even though the results of this study are drawn from a small sample, some implications are suggested for practitioner development, professional ethics and social work education.     

Computer Literacy in Automated Assessment

Summary

The following paper addresses significant questions and challenges to defining and pursuing computer literacy in the realm of assessment. This includes attention to practitioner concerns as well as validity and ethical issues. The paper concludes with discussion of promising future directions, including capitalizing on the unique characteristics of the computer and qualitatively different assessment paradigms. A balanced recognition of both the promise and the potential pitfalls of computer-assisted assessment is advocated here, as well as initiative by practitioners to assume leadership roles in shaping the synthesis of computers and clinical practice.     

Confidentiality

Abstract

Confidentiality was the ethical dilemma most frequently encountered by Israeli social workers in a 1998 national survey (Linzer, Conboy and Ain, 2002). A reanalysis of survey responses found the social workers cared about preventing violations of client privacy, promoting client self-determination, and respecting client dignity, especially when challenged by: (1) public institutions' right to know, (2) limitations of protection of client communications and information, including duty to warn, (3) child and family dilemmas, (4) informed consent ambiguities, and (5) computers and technology utilization. Social workers looked to their own counsel, colleagues, and supervisor's advice and their professional code of ethics for guidance.     

Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents

SUMMARY

This paper will focus on ethical dilemmas that arise in the treatment of adolescents with gender dysphoria. We will begin with a discussion of ethical and legal issues pertinent to the treatment of any adolescent, and then proceed to the gender dysphoric adolescent, since there is a great deal of overlap between the two areas. The authors re-view legal decisions, the existing data on adolescent decision-making, and ethical principles that may help the clinician in resolving some very complex situations. Utilizing case vignettes of three gender dysphoric adolescents, the authors provide a pragmatic illustration of the ethical dilemmas involved in evaluation and treatment of these youth. It is the authors' belief that treatment interventions should be based on respect for the adolescent's autonomy and confidentiality where he or she is deemed competent to make decisions.