Ethical Considerations in Sport and Performance Psychology
Ethical Considerations in Sport and Performance Psychology
- Edward F. EtzelEdward F. EtzelWest Virginia University
- and Leigh A. SkvarlaLeigh A. SkvarlaWest Virginia University
The field of sport, exercise, and performance psychology (SEPP) has evolved over the past 100 plus years. SEPP includes professional consultants, teachers, researchers, and students from diverse educational and training backgrounds. Persons primarily from the merging of sport science, kinesiology, and professional psychology have shaped SEPP into what it is today. Client populations typically served include athletes, coaches, and exercisers, and more recently, performing artists (musicians, singers, dancers), businesspersons, sports medicine professionals, and military personnel.
These people and phenomena have fashioned an ethical climate that is generally similar to—but in various ways different from—mainstream psychology. While the ethical values and codes of organizations like the American Psychological Association (APA) and the Association of Applied Sport Psychology (AASP) are generally comparable, the perceptions and application of these values and codes in SEPP realms may not match; this is due to the different histories of its membership, as well as the sometimes unusual work demands and atypical settings and circumstances in which SEPP persons function.
For both mainstream psychology and SEPP professionals, developments in technology and social media communications have presented ethical dilemmas for many who seek to maintain regular contact with their clientele. These issues, such as the use of technology in consulting, emphasize the importance of core ethical tenets such as privacy, confidentiality, and competence, among others, in the growing area of telehealth. In view of the rather unique ethical climate within SEPP, teaching applied ethics via classroom discussion, continued education, and sourcebooks is essential. To date, there appears to be a lack of continuity in the training and supervision of SEPP students and young professionals with respect to ethical decision making. This presents both a challenge and an opportunity to the current and next generation of scholars, researchers, and practitioners.
- Sports Psychology
Ethics is a branch of the study of philosophy and focuses on the nature of right and wrong conduct (Durant, 1973). In general, applied ethics in psychology and allied helping professionals reflects the core values of their respective professions. Two general purposes of ethics in psychology address how to both think and act in ways that (hopefully) (1) help the people professionals serve and work with (clients, research participants, students, supervisees, peers, employees) and (2) minimize the mistreatment of those people. Ideally, beneficence and nonmaleficence are the cornerstones of virtuous ethical practice (American Psychological Association, 2010).
Ethics-associated risk management (Bennett et al., 2006) focuses on minimizing harm to one’s clients (e.g., competence, duty of care) and avoiding legal damage (e.g., litigation) to oneself, one’s practice, and/or the reputability of the profession. Doing competent, efficacious work and practicing in ways that minimize harm have been and will remain quite challenging in the field of sport, exercise, and performance psychology (SEPP) in the 21st century. This article addresses selected issues associated with ethical codes, thinking, and the various faces of work in SEPP, as well as major challenges to doing so.
Ethical thinking and practice are not merely associated with sensing and managing risk (Bennett et al., 2006). According to Bennett et al. (2006), positive ethics speaks to the professional goal of helping others—doing competent, beneficial work (e.g., facilitating positive life changes for clients or students; conducting and producing useful research to add to the body of knowledge in SEPP). Benefiting clients and students through principled, skillful behavior builds trust in the field and SEPP professionals. However, unethical behavior is not uncommon in this rapidly evolving, popular field (characterized by some as the “Wild West” of psychology), calling the field and its members into question. A recent Google search of “sport[s] psychology” produced a remarkable 26,300,000 results. An examination of such searches reveals a thought-provoking and sometimes ethically concerning range of topics, persons, programs, and services.
A Very Brief History of Ethics and Ethics Codes in SEPP
Ethics in professional psychology in the United States dates back to the later 1940s when the APA formed a committee on ethics, which ultimately led to the development and publication of the first APA ethics code in 1953 (Fisher, 2003). The APA code has been revised and refined several times since the early 1950s. Numerous other helping professional organizations (e.g., the American Counseling Association, Australian Psychological Association, British Psychological Society, and Canadian Psychological Association) have crafted and adopted ethical codes over the past 60 plus years that may impact the work of member professionals and students from related backgrounds and SEPP practices (Pope, 2004).
From a domain-specific perspective, professionals recognized the need for a SEPP-linked ethics code for sport psychologists (Zeigler, 1987). Over the years, some ethics codes have been crafted, adopted, and implemented by various SEPP focused organizations. The largest of such international organizations is the Association of Applied Sport Psychology (AASP). AASP adopted a modified version of the 1992 APA ethics code in 1995 (Association of Applied Sport Psychology, 1996) but has made few changes to its code beyond content concerning technology use in recent years. Other SEPP-oriented professional organizations possessing ethics codes and/or codes of conduct are the Asian and South Pacific Association of Sport Psychology (ASPASP) and the European Federation of Sport Psychology (FEPSAC), as well as the International Society of Sport Psychology (ISSP).
The existence and adoption of the field’s ethics codes are linked to developing and maintaining trust in SEPP, its members, and its reputation for adhering to guidelines. Codes are in fact guides that emphasize personal and organizational self-regulation. Despite the fact that we are assumed to be well trained, as human beings we are susceptible to work-related errors of commission—and perhaps more frequently—of omission. Failing to consistently self-regulate undermines faith in members’ practices and can lead to skeptical views of what the field stands for (Whelan, Hill, Ginley, & Meyers, 2014). Unfortunately, like the law, ethics codes do not guarantee ethical behavior. We may prefer thinking of ourselves as good drivers, but we sometimes also choose to speed or veer into others’ lanes, intentionally or unintentionally.
Another practical purpose of SEPP ethics codes is to direct thinking and behavior in academic, research, and consulting work environments. Whereas one’s personal values may overlap with the ethics of one’s profession, ethics codes in psychology and SEPP are not intended to apply personal behavior outside of work contexts. They may, however, intersect (e.g., aspiring to be honest or to do no harm to others). Regrettably, the behavior of persons who are intentionally or unintentionally unaffiliated with SEPP professional organizations such as APA and AASP are not bound by the ethics codes of these organizations, even though they work in the field. This fact makes it difficult for SEPP organizations to provide feedback in the wake of concerns and to respectfully police the ethically questionable behaviors of unaffiliated persons (e.g., responding to concerns about professional misrepresentation in the media). Members of SEPP professional organizations may find it difficult and frustrating to observe concerning behaviors of member and nonmember peers, sometimes assuming SEPP organizations are doing little to guide the field.
The APA and AASP ethics codes are organized into two major sections to include: (1) principles and (2) standards. Interestingly, the CPA code (Canadian Psychological Association, 2016) is organized into four principles with merged standards to further include a set of introductory values statements as part of the code. In general, professional ethical principles express such core values (e.g., integrity, respect for people’s rights and dignity) as are identified by professional organizations and represent what the organizations stand for. Principles are nonenforceable, “generically broad philosophical constructs” that professionals should aim to apply to their work (Nagy, 2000, p. 5). Code principles will likely be practiced by virtuous members who share fundamental personal beliefs (Koocher & Keith-Spiegel, 2008) such as beneficence and nonmaleficence, integrity, competence, respect for people’s rights, dignity and independence, and [social] responsibility.
In comparison, code-based ethical standards describe both appropriate (e.g., obtaining informed consent; keeping accurate documentation of client interactions) and prohibited (e.g., discrimination; inappropriate multiple relationships with clients, students, or coworkers) professional behaviors more specifically. Standards are enforceable, describing what organizational members should do and avoid doing in their unique professional roles (Nagy, 2000). The consequences for violating ethical standards of practice vary from nothing (e.g., if not reported or found out, little evidence is available supporting an inquiry or complaint) to serious (e.g., reprimand, censure, or expulsion from professional membership) (Koocher & Keith-Spiegel, 2008).
Taken together, understanding the combined purposes of SEPP ethical principles and standards helps to develop a sense of how and when to employ these guides. This encourages the development and refinement of what Pope and Vasquez (2016) call “ethical intelligence.” Ethical intelligence helps foster awareness of the possible existence and onset of ethical challenges (i.e., developing one’s “ethical antennae”). Ideally, it also helps SEPP professionals and students make better decisions more frequently, and to respond and act virtuously for the benefit of those with whom they interact and serve.
Unfortunately, even with experience, insight, and ethical intelligence, ethical dilemmas can still be unpredictable and unavoidable during the course of one’s SEPP career. For example, one author was inaccurately described in the media as a sports psychiatrist. After becoming aware of the error, the author had to quickly correct it. Ultimately, even the established, understood principles and standards—as well as practical decision-making rubrics (Hadjistavrolpoulos & Malloy, 2000; Watson & Etzel, 2014)—do not provide comprehensive solutions to all of the stressful quandaries that are part and parcel of our interactions with the unique clientele, work, and settings in SEPP (see Association of Applied Sport Psychology, 2016).
Core Ethical Concepts and SEPP
Across allied SEPP organizations, several core ethical concepts are consistently relevant to appropriate ethical perspectives and action. Among many, competence, training, confidentiality, and multiple relationships are significant and controversial topics (Hankes, 2012). One must understand the associated content, values, and application of these concepts and risks related to one’s work situation(s) and be able to quickly access the code(s) of one’s SEPP-related organizations when guidance is needed. Responding ethically can be particularly challenging because work often occurs in “gray zones” (i.e., those in which sport and exercise contexts possess somewhat different cultural assumptions about values and practices) (Etzel & Watson, 2014). Examples of gray zones are meeting clients in gyms while traveling, working in training sites, having athlete clients in classes and involved in research projects, having third parties press for information, and serving as both consultant and coach. These examples, among others, can make appropriate approaches unclear and sometimes inconsistent with mainstream psychology practices.
SEPP principles and standards include many complex issues, and it would be impossible to discuss them all in one chapter. Therefore, this article focuses on core principles and standards-related information concerning competence, confidentiality, multiple relationships, and conflicts with organizational ethics demands. Information about the use of technology (telehealth) and issues associated with the teaching of ethics also follows. For more detailed information on principles and standards relevant to SEPP work settings and details about SEPP-relevant ethics codes, the reader is referred to the APA, AASP, and ISSP codes and other resources (AASP, 1996; APA, 2010; ISSP, 2009; Etzel & Watson, 2006, 2014; Gardner & Moore, 2006; Moore, 2003; Nideffer, 1981; Sachs, 1993; Singer, 1993; Whelan et al., 2014; Zeigler, 1987).
One core ethical topic—and potentially the most important one—is competence. There is an inherent public assumption that SEPP professionals are highly educated and well trained in their specialty. Thus, these two qualifications should enable one to provide quality services and consultation, teach, and/or conduct research. Without maintaining qualifications, those we serve, instruct, and study may question our abilities and the perceived value of our work. Becoming an athlete, avid exerciser, sports fan, or member of one of the many SEPP professional organizations does not in any way make one a competent or qualified SEPP practitioner (Brown & Cogan, 2006).
SEPP ethics codes speak to knowing one’s strengths and limitations linked to one’s education and training, which change over time, and the need to continually work within personal boundaries of competence. For example, APA Standard 2.01 directs that (sport) psychologists “provide services, teach and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience” (APA, 2010). Likewise, AASP’s ethical standard 2a has further stated that
AASP members represent diverse academic and professional backgrounds. These different training histories provide different competencies. Those trained in clinical and counseling psychology must be aware of potential limitations in their sport science competencies. AASP members trained in the sport sciences must be aware of their limitations in clinical and counseling psychology. Individuals from different training backgrounds must deliver services, teach, and conduct research only within the boundaries of their competence.(AASP, 1996)
SEPP professionals tend to “wear many hats” during their work days, often coming from different and sometimes mixed educational and training backgrounds that challenge their real and perceived competence. For example, a person with a terminal degree in kinesiology/sport sciences would probably have a very different set of academic course work and supervised training than a person who comes from a professional psychology or counseling program and who takes additional coursework in SEPP topics and supervises sport psychology practice.
Given the expanding scope of SEPP-related work and the seemingly nonstop stream of information, it is nearly impossible to keep up with the comprehensive body of knowledge in the field. SEPP professionals are not expected to maintain perfect competence levels, but rather can simply be “good enough”—at least meeting, and hopefully exceeding, perceived general standards of care (Koocher & Keith-Spiegel, 2008).
How does an individual decide that she or he is fundamentally competent to work in SEPP? An assessment of the strength and usefulness of one’s educational foundation, applied training experiences, supervision, continued education, and growing cultural competency is essential to this assessment. Determining whether one is truly competent can be a daunting but important task. Part of the challenge is that there is not one standardized model for training in SEPP, as is the case in professional psychology or counseling.
Despite many developments and pathways in the field over the past 60 years, there are no established within-profession “standards of care” to use as competence benchmarks (Anderson & Tod, 2011; Baillie, 2014). Fortunately, there are some rather useful guides to self-assess competence, including the APA Proficiency in Sport Psychology (APA, 2003) and AASP’s Certified Consultant criteria (AASP, 2016). At the time that this article is being written, AASP is using a Job Task Analysis (JTA) to assess core knowledge perhaps linked to competence among SEPP professionals (AASP, e-mail communication, February 16, 2016).
In recent years, cultural competence in a diverse world has been established as critical to ethical education and studies, training, and practice (Fisher & Anders, 2010). AASP Standard 3a speaks to the need to appreciate the potential impact of human differences on their work and the need to be proficient when working with people from diverse backgrounds:
AASP members recognize that differences of age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, or socioeconomic status can significantly affect their work. AASP members working with specific populations have the responsibility to develop the necessary skills to be competent with these populations, or they make appropriate referrals.(AASP, 1996)
In addition, APA’s Standard 2.01 states:
Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation or supervision necessary to ensure the competence of their services, or they make appropriate referrals.(APA, 2010)
For example, deciding to work with youth sport athletes, business managers, dancers, military personnel, college athletes, and the like, when one has not done so requires an honest self-assessment, consultation, and perhaps retraining and work under supervision.
Finally, competence may also be exceeded, overextended, or lost for various reasons. As suggested earlier, it is important to recognize that we have and engage multiple competencies that change but that are not all encompassing or lifelong (Morris & Terry, 2011). Sometimes one’s boundaries are stretched and strained. For example, one may be tempted to go beyond current competency boundaries (e.g., work with unfamiliar populations or settings, employ methods one is not qualified to use) because of curiosity, naiveté, an ongoing helping relationship, or perhaps for other ego-directed reasons (Gardner & Moore, 2006). These stretches are unethical and must be avoided. One might also become impaired as a result of physical or mental illness, other life stresses linked to family relationships, finances, job changes, changes in work culture, overworking, poor self-care, and/or underrecovery (Koocher & Keith-Spiegel, 2008). Impairment may also be the result of boredom or attraction or repulsion to clients or peers in the workplace. One may lack awareness of, or be unwilling to examine, the need to self-monitor, consult, and address the impact these changes can have on work quality (Pope et al., 2006).
Another core ethical topic is confidentiality. Confidentiality involves establishing formal agreements between SEPP professionals and clients to not reveal information that the clients would not want disclosed to others. Confidentiality is linked to the values of beneficence (doing good work) and nonmaleficence (avoiding harm). Confidentiality is necessary to establish and maintain trust in SEPP professionals, their relationships, and work. Without confidentiality, those served may not be inclined to share sensitive personal information. For example, an athlete who seeks consultation for both a sensitive performance and a clinical issue (e.g., challenges to self-confidence, relationship with a coach, alcohol use, mood swings) would likely not be open to seeking help and candidly discussing such issues.
Agreements to keep information confidential are normally provided by clients of majority age (i.e., 18 years of age and older) in writing. Their voluntary informed consent allows for SEPP professionals to provide services to them and work together with them under specific, clearly communicated conditions prior to the start of a professional relationship. In the case of clients or students who are younger than 18 years of age, assent to work with, assist, or consult must be provided by parents or legal guardians (Miller, Drotar, & Kodish, 2004). For example, when working with a team of mixed-age athletes, the SEPP practitioner would be required to get written permission from the parents of athletes who are minors before the consultation begins.
Confidential data from sport or exercise-specific tests and instruments, as well as any records of consultation, would be inappropriate to reveal to others. Even the reference to the existence of a past or current professional relationship with identifiable others (e.g., while presenting at conferences) without written or documented verbal permission would likely be a breach of confidentiality and may constitute malpractice.
Many technological challenges exist to protect or threaten confidentiality in today’s world. The use of cell phones, social media platforms, computerized records, loss of a USB device, and online data collection are some examples. Alternatively, ethical “slips” such as leaving paperwork on a desk, discussing privileged information in public or in the media about a client or a student’s grade, accidentally sharing information with a coach or parent, or mistakenly sending a private e-mail to a public listserv are easy ways to compromise confidentiality (Etzel, 2014). The reader is directed to AASP Standard 18, APA Standard 4, and ISSP Principle B for more specific code-related information.
There are other challenges to maintaining confidentiality and the application of mainstream psychology ethics–especially in applied consultation—where one can still be ethical but may need to “keep loose” (Andersen, Van Raalte, & Brewer, 2001). These challenges tend to be associated with the varied settings in which SEPP professionals interact with others. For example, services may be provided outside of the standard 50-minute hour work arrangement. Thus, SEPP professionals and supervised student consultants often interact with athletes, coaches, and other confidential service recipients at athletics facilities, fields and courtside, in team buses, or perhaps in the field with military units, on patrol with police officers, or off-stage with dancers or musicians.
Professors and graduate students who teach are uniquely challenged with many ethical issues including nondisclosure of various types of information (Sachs, 2014). SEPP professionals may encounter overlaps with the law and the ethical practice of confidentiality. For example, academics often possess information that needs to be legally kept private (e.g., grades, attendance) under the Federal Educational Rights and Privacy Act (FERPA) in the United States (U.S. Department of Education, 2015). When functioning in academic roles, SEPP professionals and student-teachers need to be acutely aware of the law and its application in their state/province.
Similarly, SEPP professionals may possess Health Insurance Portability and Accountability Act (HIPAA)-protected information in their work with various clients. They need to be acutely aware of federal law and must obtain a written release of information to discuss or reveal this kind of information. For example, SEPP professionals working in sports medicine or exercise settings will need to use great care when discussing or sharing protected health information (PHI) with third-party providers (Zizzi & Shannon, 2014).
Work in the SEPP field often takes place in varied, uncommon settings (e.g., on airplane flights, in locker rooms) and overlapping roles (e.g., clients who may be students and vice versa; Watson, Clement, Harris, Leffingwell, & Hurst, 2006) that may cross traditional professional boundaries (Stapleton, Hankes, Hays, & Parham, 2010). Professionals and students may be involved in uncommon cultures (e.g., Olympic sports, military special forces; Haberl & Peterson, 2006) and sometimes compatible roles (e.g., students who may also be parents or coaches), as well as conflicting roles (e.g., dissertation chairperson and supervisor), with a broad range of clientele and students. SEPP work also involves multiple interactions and changing (in)formal relationships with many people. Accordingly, multiple relationships can be seen as potentially harmful to others and should be avoided. One should anticipate and expect to encounter (un)predictable multiple relationships with students, clients, research participants, coaches, administrators, medical staff, management, and so on, in one’s work.
Common examples of such situations in SEPP are having friends or colleagues refer their children to you for consultation; having a college athlete whose team you are working with enroll in a class you teach (or vice versa); receiving requests to connect on social media; being attracted to fit athletes, exercisers, or students (and perhaps having them attracted to you); being asked to exercise or play a sport with clients; being repulsed by persons involved in certain activities (e.g., boxing, performance enhancing drug [PED] use) or personalities (e.g., obnoxious coaches); having requests to barter lessons for consultation services; being offered free tickets to events by athlete-management clients; traveling with teams and individual clients; and meeting others in public places (“the supermarket [or gym] effect”).
While some of these are small-world encounters, usually with limited likelihood for causing harm, other everyday encounters pose a greater risk (e.g., starting an intimate relationship or business; friending a client via social media; having a drink and dinner with a client; having a client stay or vacation with your family). In the SEPP culture, most people would likely avoid these connections. However some might not see such connections as harmless out of naiveté or the observation that peers do these behaviors with little or no consequences. Some SEPP-relevant literature addresses these issues that are not often discussed in the clinical literature (see Pope, Sonne, & Greene, 2006).
Conflicts with Professional Ethics and Organizational Culture
It is not uncommon for conflicts and functional disconnects to develop between one’s professional ethical values and those of organizations they work with or within. It takes time to understand cultures, people, and their interactions, as well as how these may change with new demands, leadership, and players. The values and activities of sport or other performance-related cultures may cause considerable moral distress, making it difficult to commit to work with and for others (Pope & Vasquez, 2016). For example, some SEPP professionals and student trainees work in what are known as closed cultures, such as collegiate and pro-sport or other demanding performance settings, like law enforcement or the military.
Each of these settings has its own macro (e.g., the sport of baseball; dance as an art form) and micro (e.g., a specific baseball team; a particular dance company) cultures. These groups and their members may see things in other ways and treat athletes, exercisers, and/or performers quite differently than SEPP students and professionals would (e.g., youth athletes are little adults and should be treated that way; do not speak about what happens in our unit or the basketball family). Unfortunately, organizations with which we become affiliated may publicly espouse one set of values and act in very different ways—betraying one’s sense of trust in their ethical principles and the people involved in such groups (e.g., the child sexual assault scandal centering on Penn State’s football program) (Pope, 2015).
These instances may make work difficult, especially when one becomes aware of them in confidential settings. An example is to discuss with administration and management the treatment of an athlete who may have incurred a mild traumatic brain injury (i.e., concussion), but who has been compelled to return to play prematurely or is not provided with appropriate support for rehabilitation. In such cultures of risk and urgency like professional and collegiate sport, there may be a press to keep everyone involved and contributing regardless of health status; injury, suffering, and dysfunction are discounted. Therefore, the values of these subcultures may be inconsistent with the SEPP practitioner’s ethical tenets.
How should one address such ethical predicaments? To consider and possibly respond to these troubles, ethics codes recommend that one seek ways to rectify perceived challenges if possible, such as speaking to coaches, management, or those who set policy and shape cultures. In some cases, this recourse is made very difficult, or even impossible, by informed consent agreements with clients that they are not to discuss information revealed in private.
Before responding to these troubles, it is generally prudent to seek the consultation of ethically knowledgeable peers. Professional organizations’ ethics staff and state ethics boards are available to help us think through challenges. Advocating for those served within the organization and potentially promoting useful change in the organization are options that come with a price. Such action or inaction takes courage and conviction. It can come with personal, financial, and professional risks, including emotional ambivalence or distress, ostracism, loss of job status, and/or termination (Heil & Etzel, 2016).
Social Media and Telehealth in SEPP
The ethics of practice in SEPP have arguably become more complex as technology-based options for consulting, psychotherapy, teaching, and research have increased over the years (Nickelson, 1998; Watson, Schinke, & Sampson, 2014). Technology has opened pathways of near instantaneous communication that previous generations of SEPP persons did not have to manage in educational, applied, or research settings. Where there was once simply the option to meet face to face with an athlete or a client, there are now multiple avenues one can choose, such as e-mail, text messaging, and social media networks (Facebook, Twitter, etc.). Using technology to consult has several implications, the most prominent being the clients’ confidentiality and privacy, and the consultant and clients’ competence in using these technologies.
Given the widely accepted fact that “NOTHING ON THE INTERNET IS PRIVATE!!!” (Baird, 2014, p. 58), SEPP professionals should be mindful of their use of technology in the delivery of sport psychology services. It is suggested that practitioners discuss telehealth options with their clients during the initial session and/or when reviewing informed consent procedures. For instance, practitioners, researchers, and educators should not assume that clients, students, and research participants know that e-mail is not a secure form of communication (Luxton, Nelson, & Maheu, 2016), even if it is a password-protected account or has a certain level of encryption.
A specific waiver or other written document that outlines potential breaches of confidentiality and limits to privacy may be one way to handle a client’s request for technology-based sessions (see AASP Ethics Code, 26a-f). Delineating appropriate versus inappropriate use of these lines of communication may also be needed; this may include times that the professional does and does not respond, how much time is expected for a typical response, the content that emails should or should not include, and the like. It might also include an overview of how data are stored—and for what length of time—on the professional’s computer, and what clients should do if technology fails to cooperate during a scheduled meeting or session (Association for Counseling and Therapy Online, n.d.).
Furthermore, SEPP practitioners are encouraged to educate clients about their practice’s use of the Internet as it pertains to their case or care. For instance, does a consultant watch away-games on YouTube? Does he or she follow the team’s official Twitter account? How about looking up scores or percentiles, or other athlete-specific statistics using Google? According to Kolmes, Nagel, and Anthony (2011), it is the practitioner’s responsibility to disclose to clients “whether they utilize search engines as a standard means of collecting client information, whether this is done routinely as part of care, or whether there are particular circumstances (i.e., emergencies) in which they may obtain this information” (p. 21). Incorporating these types of searches into clinical notes is important (Kolmes et al., 2011).
Another consideration beyond educating the client about confidentiality and privacy when working with technology is how the use of the Internet and social media may affect the overall relationship between practitioner and client. Former APA Ethics Director Stephen Behnke noted the difference between a face-to-face client who is going on vacation and wants to do an Internet-based check-in and a second client with whom the practitioner has a strictly online-based relationship. Behnke asks, “What sorts of issues are appropriate to treat in that [latter] manner? How do the relevant jurisdiction’s laws and regulations apply to the work you are doing?” (Martin, 2010, p. 32). Thus, SEPP persons must consider the context(s) in which solely telehealth services are offered, and to what extent these cases are appropriate for this type of communication. They must also take it upon themselves to learn the legality of delivering services across state or country lines, how these legal issues may help or burden the consultant–client relationship, and consider liability and the malpractice issues that could occur (National Association of Social Workers, 2005).
Furthermore, SEPP students and professionals must consider both their own competence with technology-based services or platforms and the competence of the client(s) using them (Watson, Schinke, & Sampson, 2014). According to AASP ethics code Standard 2, “AASP members provide services, teach, or conduct research in new areas only after taking the necessary actions to guarantee a high level of competence in those areas.” Thus, a practitioner needs to have specific training in order to successfully navigate the ever-changing, ever-growing world of social media, or to stay up to date with the latest features of, for example, video-conferencing. We suggest that readers view technology-based services as an ever-moving target that is constantly morphing in its development and usage. By this metaphor, it is likely insufficient to provide one consent form that covers all of the possible telehealth services and likely inaccurate to consider oneself an expert in all areas of telehealth without proper continuing education, review of organizational membership ethics, and peer consultation.
Additionally, SEPP professionals have an obligation to consider the client’s level of proficiency in using these platforms. Asking a client to learn how to use Skype so that you can have a session is likely working to your benefit rather to the client’s advantage. This kind of request could result in making a client feel uncomfortable and would consequently be in direct violation of AASP ethical standard 26a: “AASP members should only incorporate the various forms of technology in their professional and scientific work in which they have appropriate technical and practical expertise, and when such technology does not subject another party to harm or discomfort.”
Another point of contention among some practitioners is the use of social media for personal relations or networking. While some ethics codes, including the American Counseling Association’s standard A5e, are clear about avoiding “personal virtual relationships” with clients, other ethics codes do not specifically address connections via Facebook, Twitter, or other platforms such as Snapchat, Instagram, or personal blogs. This presents a challenge, particularly for the tech-savvy student or professional to whom technology-based communications seem efficient and part of everyday life. Nevertheless, the possibility of dual relationships, breaches of confidentiality, unclear boundary behaviors, and self-disclosure may become more likely with increased use of social media for personal and professional activities. It is understandable that many professionals wish to be friendly with their clients, but one must not be a friend. This line is a delicate one that is constantly shifting as new ways to connect, and new ways to deliver services, evolve and become commonplace.
This constant shifting begets questions related to accessibility, security, and storage of client records. For instance, are these technologies accessible to you and your clients? To what extent are upgrades or add-on features hindering your work? Additionally, it remains important to monitor possible security threats during tasks such as data back-ups, file storage, and software program updates, as these relate to client privacy and confidentiality. While it is assumed that SEPP persons intend to be helpful, fully assessing the risks involved with technology-based services and being careful and competent when using e-mail, phone, video-conferencing, and social media platforms remains paramount.
A counterargument can be made for the necessity, and beneficial outcomes, of technology-based communication between SEPP professionals and their clients. “Behavioral telehealth can help provide treatment to individuals in remote or inaccessible areas,” as well as to individuals who are homebound due to injury, athletes who are traveling, and clients who have limited means to travel (Scheetz & Barnett, n.d.). Without the use of technology, SEPP persons, among other helping professionals, may not be able to reach certain clientele who could greatly benefit from their services. For instance, an athlete recovering from an anterior cruciate ligament (ACL) surgery may find it useful to connect with a consultant to discuss physical therapy goals and to gain psychoeducation on skills such as healing imagery that may aid in his or her pain management and recovery. Another athlete competing overseas for an international or Olympic event may find it grounding to continue a mental skills training program or complete check-ins with a consultant as travel permits. These are just a few of the countless examples of how technology can enhance the relationship and productivity between a client and the SEPP service provider.
Telehealth, or technology-based services, may also be beneficial for both supervision and case consultations (Ohio Psychological Association, 2009). Supervisors and their students may not always be in the same room or building throughout a student’s training. Thus, when a student needs a quick response, a text message or e-mail may be a logical way to contact one’s supervisor for assistance or advice. Similarly, two colleagues—as long as they have no liability for each other’s clinical decisions in their SEPP practice—may choose to de-identify some of their cases and then discuss them via Skype, or solicit general feedback via an e-mail listerv. These technological means to enhance competence, education, and self-awareness can be vital to the well-being of those whom SEPP persons serve.
Teaching Ethics in SEPP
Ethics and ethical decision making serve as core components of training in many psychology, counseling, and counselor education programs across the United States (ACA, 2014; APA, 2010). While SEPP graduate programs share some similarities with these fields of study in terms of content, theories, and ethical tenants, the amount and models of ethics training vary greatly. This variability is a product of the SEPP profession lacking a standardized approach to teaching and incorporating ethics into educational, research, and applied settings. As Etzel and Watson (n.d.) wrote: “there is not a cookbook of effective teaching or a roadmap for the ethical practice” for doing what can be considered a “good job” in educating SEPP students. In order for the field to move forward in the eyes of its members and the clients whom they serve, a clear consensus on ethics training is warranted.
Watson, Zizzi, and Etzel (2006) have discussed the importance of ethical training in graduate programs, reporting that approximately two-thirds of programs that responded to an e-mail-based survey (n = 47) required training in ethics. Training in these programs came mostly in the form of ethics infused in other coursework and topics. For instance, a course on multiculturalism and diversity may include a week of discussion on the ethics of consulting with athletes who have different individual or cultural characteristics than those with which the consultant is familiar. Another example might be a writing assignment that incorporates ethical and legal considerations as part of a case study focused on performance enhancement in youth athletes.
Yet a third example stems from Handelsman’s (1986) discussion of teaching ethics while students are in practicum or internship, and thus using time during supervision to work through ethical or legal issues at their placements. Handelsman has argued that the weaving of ethics into the fabric of these courses is not only insufficient, but also potentially dangerous to students’ training. He noted that we cannot assume that the supervision being provided is of quality—although we might like to think so. We have to question the supervisor’s level of competence with ethics and how an ethics code may apply to situations that students bring to him or her. Additionally, he suggests that only a sampling of ethical issues may arise during supervision, thus limiting familiarity with other important principles and standards. It may be the case, for instance, that the ethics surrounding note-taking and confidentiality come up, but multicultural competence, practitioner self-care, and case termination are not examined.
To understand why ethics is not taught as a stand-alone course, Fine and Ulrich (1988) have suggested that we consider the attitude toward ethics from both traditional philosophical and psychological perspectives:
Ethics is generally considered the appropriate subject matter of philosophy, insofar as psychologists typically treat ethics as a tool to assist them in conducting their clinical activities, but not as a primary subject matter in itself . . . [and] as a result of philosophy's greater acquaintance with ethical subject matter, it is better suited to assist when there arise ethical dilemmas that cannot easily be resolved with . . . ethical codes.(p. 543)
Returning to Watson et al.’s (2006) findings, we find that these traditional perspectives have consequences for the contemporary student. The authors noted: “respondents [to the survey of graduate programs] did not feel as if students were completely prepared for either the ethical or legal issues that they will face in their professional careers” (p. 5). Given the emphasis on gatekeeping in health-related service professions, it is critical that SEPP persons consider the implications of a generation of students and young professionals who may not be well versed in the ethical and legal issues of the field. With the increased use of technology and overall growth of SEPP, ethical issues such as confidentiality, privacy, boundaries, preexisting relationships, and competence—intellectual, emotional, and experiential—may become amplified (Etzel, Harris, Sachs, & Watson, 2015).
Continuing education is one way to encourage SEPP students and professionals to monitor their competencies and maintain their self-awareness of ethics applications in their respective training programs and careers. To take a page from ACA’s playbook, professionals could be regularly required to fulfill a specific number of hours of ethics training in order to renew their license or certification. For example, in West Virginia and Pennsylvania, continuing education in ethics is not currently required for those with the CC-AASP designation or renewal.
In addition, instructors, academic advisors, and professional organization leaders are encouraged to help students and professionals navigate, develop, and maintain networks for supervision, consultation, and referrals. These networks can serve as guides to check competencies, discuss ideas via case consultations, and assist in providing ethical advice for decision making. As noted above, professional organizations can also ensure that members are able to easily locate contact information (e.g., websites, phone numbers) for ethics committee members and state ethics boards. These committees and boards should be used proactively, helping individuals to answer questions and seek consultation.
Some students and professionals may not be interested in studies of SEPP ethics. Nevertheless, comprehending the principles and applications is essential for anyone wishing to succeed as a responsible, respected SEPP teacher, researcher, and/or practitioner.
Applied ethics within SEPP will not go away. As the field continues to grow, working with traditional and new clientele in challenging settings will present more and more tests of ethical awareness and practice. Competent SEPP professionals will need to not only appreciate the fundamental values that underlie the ethics codes of allied fields, but also be able to put these values into practice for the good of their students, clients, and research participants. Students will need to be well educated and trained in ethics—hopefully infused into a more uniform, interdisciplinary SEPP curricula.
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