NEW ZEALAND

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PSYCHOTOCISTS BOARD

BOARD PSYCHOLOGISTS

poper towordsdevelopingguidelines: Discussion Psychology servicesdeliveredvio the interneft

Februory2011 Why might we need guidelines on this topic?
ond roises significont "Behoviourolteleheolth o ropidlyevolvingfieldthat offersgreol promise is ore ond occesslo thesetechnologies risk".2 ropid growth of lelecommunicolions The ihe delivery professionol of chongingthe woys people communicoleond inleroct,including psychology services. (the Compefencies) (the Code) ond the Core Compelenciesa TheBoord's Code of Elhicss providethe foundolions thisdocument. be thol Any guidelines moy subsequently published for In lo would be supplementory thoseprimorydocuments. lhe event of ony opporeni in ond the Code or Competencies trodilionolmodesof between suchguidelines discreponcy professionol of octivity,the Code ond lhe usuolstondords compelence would toke preceoence. objectives: lhe In developingguidelines Boordwould wont lo ochieve the following . . . . . generotedby technologicol scenorios to To olert oll psychologists the possible in of ond chongingpotterns communicotion sociely. odvonces thot moy be posed by these wiih regordlo lhe ethicolchollenges To roiseoworeness generoted. os communicotionforms, well os the opportunities communicotion of To expond horizons prociice io includewhol moy be preferred thol moy opply. whileolsomiiigotingony odditionolrisks medio for someclienls, evidence fo sofe prociice whilethe reseorch fromework ensure To provideo regulotory ond consolidoies. deliveredvio ihe internetevolves for the efficocy of inlerventions ihe To meet itsslolutoryobligotionof ossuring publicof sofe proctice.

A coulionory nole: Any guidelineslhe Boordmight publishwould qddresslhe risksroised by the TheBoorddoes nol inlend lo condone or use of lhe inlernello deliver psychologicolservices. encouroge lhe use of such technologieslo deliver servicesos in focl ils posilionis one of proceeding couliously,given lhe relolive lock of reseorchevidence on lhe efficocy of some services. A fundomentol principle is thof ony psychologicolservicedelivered vio lhe internelshould meel lhe equivolenl sfondordsof core os would be provided in o foce-lo-foce consullotion. prociisingvio lhe inlernel musl uphold ihe requiredstondordsof compelence Psychologists ond conducl os expecled in olher formsof servicedelivery,including ociing in occordonce lf work lo supervision. the quolity of core is likely with the Code of Elhicsond toking professionol lo be compromisedby the delivery medium,fhen lhe proclilioneris urged lo reconsiderlhe
I ThePsychologists poper for publicotionin Februory l. lt will be revisiied 201 loter in the yeor for Boordopproved thisdiscussion for considerotion reworkingos best proctice guidelines. 2 Koocher,G. ond Morroy,E..2000, A of Generol.Professionol Regulotion Telepsychology: Survey StoteAttorneys of Reseorch ond Proctice,vol 31, No 5 , 503508{ poge 507) Psychology: 3 Code of Ethics Psychologists workingin Aoteoroo/ New Zeolond,2002 for I Core Competenciesfor the Procticeof Psychology New Zeolond,July2O0B in

wisdom of delivering services vio lhis melhod. These guidelines opply io oll slreoms of professionol psychologicql services.

What serviees would theseguidelines address?

psychology thot mokesuseof service Theguidelines would referto ony type of professionol new clienls. technologies connectpsychologists theirocluol or polentiol to ond online os Psychologicol octivitymoy include(but is not limiiedlo) interoction on odjunct lo other lhe of foce-lo-focework,stondolone contocl, onlinelesting,coreercounselling, provision li odvisory services reseorch. moy includeihe development or informoiion otherresources, or progrommes, with or withoutthe of resources clienisto work throughonline-self-help for psychologisl's directinvolvemenl. video comero livefeed lopiops,mobilephones, Psychologicol services moy usecompuiers, moy be The os ond hond helddevices lhe mediumof communicotion. communicotion unilolerol bidirectionol or ond mov occur vio: r Emoil. r Texting. . Video clips. . Messoging (synchronous osynchronous) or . . Chotrooms. . Onlinemessoge boords. . Onlinephone systems (withor wilhout comerolor voice optionssuchos Skypeor Oovoo). pothwoys. provides flexible ond chongingcommunicotion Theuseof onlinetechnologies 1o): moy include (bul ore not restricted Scenorios . . . . or Contoci by emoil or texl to moke oppoinlments to convey briefmessoges. proclice,e.9.,usingonlinelechnologies focilitoteond supportfoceio Onlineossisted to-foce procticesuchos clients'checkingin' vio text or sendingon emoilof supportor to reinforce homework. psychology service. ond os Onlineossessmenl consullotion port of on orgonisolionol with moy slorfonlineond then shifito foceProfessionol counselling relolionships clients for lo-foce. A clienl moy be onlineexclusively sometime beforethey con feel comfortobleenoughto come to o foce-to-focemeeting.Forexomple,one proctitioner with noted thot oflen who hove difficulties child pornogrophy who workswith clients to will onlinebeforedroppingtheirononymity self-referring clienls wonl lo oskquestions in come to o session person. relolionships clients with esloblished foce-to-foceconloct by Professionol counselling such moy be supporiedor coniinuedwilh onlinesessions, os with people who trovel on thot prevenlthem coming to foce-lo-focesession o frequently hove heolthissues or
r aar r lnr hncic

(nevermeet with thot sioy onlineexclusively relotionships clienls Professionol counselling foce-to-foce).

posesodditionolelhicol chollenges. involvemenl group communicotions in A psychologist's internet-bqsed onlinegroupssuchos Theronge of services thot moy be offeredincludes groups. Suchgroupsmoy ond newsond discussion bulletinboords,chot room supportgroups, moy hove o role of initioting group,for o The hove on "osk-the-expert" dimension. psychologist independenily. eoch In exomple,for supportpurposes, ihen lhol group coniinues bul of the shoulddeclorelheir role,ond the limiis thol role,lo corefully circumstonce psychologist monoge expectotions. ond o Professionol services involvepurposeful ond directedcontoct between o psychologist on clientor potenliolclientfor the objectiveof mokingon oppoinlmenl,delivering intervention, This ond sociol blogging on or underioking ossessment engogingin o consultotion. excludes guidelines These where one of the porties involvedhoppensto be o psychologist. networking which ore relotively impersonol moy include but onlineservices olsowould not oddress noturesuchos websiies offeringtheseopportunilies. ossessmeni odvice of o psychologicol ond

SectionA: Regulatory issues

to deliveredvio the internetposeodditionolchollenges the regulotor Psychologicol services jurisdiction, odditionolrisks thol moy orisefrom delivering lhe becouseof the need to clorify ore on vio services thismode, ond becouseof the lock of reseorch efficocy.These considered seporotely.

may be practisedwhile not being in the same 1. Telepsychology geographical areaor countryas the client.
of o) Protection the title "psychologist" Act Competence Assuronce 2003(theAct) slotesthoi o proctitioner TheHeolthProctilioners in only if registered New Zeolond,but thiswould moy represent him-or herself o psychologisl os providers who ore torgetingNew bosed service be difficulito monitoror opply to overseos in who proctise New Zeolond, online.TheAct isintendedto opply to proclitioners Zeolonders where ony oct of Act l96l5 slotesthot for the purposes jurisdiciion, but section7 of the Crimes to formingporl of ony offence,or ony eveni necessory the complelionof ony or omission the offence shollbe deemed to hove been commilted in offence,occursin New Zeolond, New Zeolond,wheiher the personchorged wilh the offencewos in New Zeolondor not of the time of ihe oct, omission, event. or working in cyberspoce b) New Zeolondregisieredpsychologisls psychologist who wishes work vio lhe internetshould lo Ethicolly, New Zeolondregistered ony lf from which they recruitclients. you enterlhe stote or counlryvio register ony jurisdiction in who in technology,you moy be deemed to be proctising thot couniry.Psychologisls ore they reseorch wilh clients onlineore odvisedfo ensure registered New Zeolondwho proctise in obligotions thot geogrophicollocoiion priorto occepling clients of the legol ond regulotory from thot locolion. in Act con onlybe oppliedlo prolectthe "public"(persons) it thot the HPCA Although islikely Aci if o proctitioner bosedin New Zeolond is 7 New Zeolond, undersections ond 8 of the HPCA in oble ond enlitledlo proctise New Zeolond(notwithstonding ond cloimsto be o psychologisl io then thismoy be sufficient support thot theirproposedclientelemoy be bosed overseos) is hos stotedthot the offerof service the chorgesunderlhe Act (unless proclitioner expressly hondleony offer ond does not intentionolly or nol ovoilobleio New Zeolondresidents citizens or provideony service). working with clienls in New Zeolond c) Overseospsychologisls psychologist in who knowingly setsout to proctisein New Zeolondshouldregisler Any overseos deliveredto service New Zeolondpriorto commencingthot prociice.Any psychologicol in underthe HPCA is who ore in New Zeolond deemed lo be "proctising New Zeolond" clienls proctitioners ochieve the objecliveof sofeguording New Zeolond the to Act, which regulotes ihol o public.Howeverin prociice thiswould be difficult monitorond enforce. lt ispossible to provider workingonlinemoy nol know lhe geogrophicollocotionof o clienl. d) Deolingwith comploinls orisingfrom online psychologicolservices of ihe A service deliveredover the internetroises possibility o complointoccurringin one when o complointismode it isihe but being heord in onother.In monyjurisdiclions iurisdiclion ploce of residence the clientthot isossumed be the jurisdiction opplies, thol ond it is to of procticewould be thot lhosestondords ond legolobligotions lhe proctitioner's ogoinst meosureo. moy o beyond New Zeolond's borders, New Zeolondprcctilioner Whereo comploinontresides Whetheror not lhol imposedin thot oiher jurisdiction. ond regulotions be exposedto rules woulddepend on lhe legolrelolionship withinNew Zeolond would hove consequences
s Sectlon of the Summory Act underthe ihot sections - 7 of the Crimes opply to the offenceprovisions 5 Proceedings ensures Act 3 HPCAAct.

moy olsobe TheNew Zeolondproctilioner belween New Zeolondond lhe other country. to os offected if lrovelling ihot country.Accordingly, noted obove, New Zeolondprociitioners beforedelivering services with ihe requirements olher countries of shouldocquoint themselves there. psychologisi who isproctising throughthe internet obout o New Zeolondregisiered Comploints Any to Boordfrom onotherjurisdiclion. moy be referred the New ZeolondPsychologists by of competenceond conductcould be undertoken the ossessment thot psychologist's with Boordond itsogents,suchos o Professionol Conduct Committee(PCC).Communicoiion the comploinont could be conductedvio technology. who is {or In New Zeolondthe Boordcon only occept o complointif il concernso psychologist whereosthe Heolthond Disobility Commissioner could wos of the relevonitime) on its Register, professionol. look of o complointfrom o non-registered issues roisedby the As otherjurisdiciions chollengedby the someethicolond regulolory ore in services, time lhere moy be 'memorondumof useof the inlernello deliverpsychologicol jurisdictions monoge thisissue. Boord (MOU) to The understonding' developed between similor working regulotory outhorities thot psychologists so with oiher psychology could initioteMOUs jurisdiclions be held occounloble for theirproclice.Forexomple,the New Zeolond ocross con Psychologists Boordcould receiveo comploinlfrom o New Zeolondclientobout o foreignwith thot proctitioner's in bosed proctitioner ond followogreed protocols colloboroting jurisdiciion. Wilhouisuchon regislering the body to process complointin the psychologist's by MOUthe Boordmoy hqve no, or limiled,obiliiyto receiveond oct on ony comploints o New Zeolondclieni ogoinsto foreignpsychologisl.

practiceof 2. ls there a role for the Internetin the professional psychology?

Perceived benefits Advocotes of the use of the computer delivered psychologicol servicesemphosise poientiol benefiis. Online servicesmoy offer: l. i In c re o s e d o c c e s s fo r b o th cl i enl sond psychol ogi si s,ncl udi ng . serving people with lessmobility. . those in remote or rurol oreos or who hove relocoted io onother counlry where there ore longuoge or culturol borriers. . lhose who ore disobled physicollyor psychologicolly (e.9., sociol phobios). . informol coregivers,i.e., coretokers of ihose fomily members who require or extroordinory support ond core through disobility,illness dementio. . giving more choice of psychologistfor those in oreos with few services,ond increosing lhe ovoilobilily of speciolised services. . providing increosed occess for time reslricted people who connot eosily come to o iypicol doy lime proctice, e.9., shiftworkers,people without reody childcore. o the ovoilobility ond convenience of being oble to send ond receive messogesot o n y ti m e o f th e d o y o r ni ghl . . providing increosed occess to ihose who wont lo opprooch for help (or enquire) but ore too emborrossed or troumotised to do so in person, or who feel using psychologicol servicesis sligmotising. Reduced relionce on leoving messogeswith intermediories,voicemoil or ploying " te l e p h o n e to g " . A theropeutic octivity for those who experience lhe process of writing os helpful.The oct of writing mcy enhonce self-reflectionby ollowing opportunitiesfor review of whot hos been written ond therebv increose the ownership of issues.

2. 3.

to A record of communicotions referio loter. for ond ossessment services coreerdevelopmentpurposes. Discrete occessto odvisory isless inhibiting lhon in person. which someclienlsfeel A service For choiceond control. somethe internet Enhonced clientoutonomyby increosing relotionship moy reduce the power differencebetween clientond psychologist. cues which isless ombiguous confusedby porolinguistic or 8. A form of communicotion moy be o (such body longuoge, oppeoronce) ond therefore occent or physicol os informotion. more cleor woy of communicoting e.9.,gomers,people for 9. More cullurolly opproprioteservices somegroupsin society, odvoncedpeople,peoplewho workin the who usethe inlernelo lot,technologicolly lt technologyindusiry. could olsobe more ollroctivefor somegroupssuchos teenogers vio ond comfortoblewiih communicotion the inlernel. who ore very fomilior ,l0. informotion ond resource moteriol. Eosier occessto supplementory of ond I l. Focilitotion supervisory educotionolopportunities. 4. 5. 6. 7. Polenlioldsks moy orisewilh regord to: Potentiol risks l. Assessmenl . Thereductionof informolion moy leod to suchos the lock of non-verbols Video links evoding ossessmenl. or importontcues being missed, ihe reol issues on the informotion ovoiloblebut constroints observoiions moy help increose moy remoin. . Thegreotererrormorginond lock of physicol cues moy meon o confident connot be eliminoted. diognoses connot be mode or differentiol diognosis

ond 2. Miscommunicolion misunderstonding . Emoils thon lelters, ond moy lherefore ond textsmoy be more likeposlcords increose the polentiolfor misunderslonding. . Thereduced opportunilyfor spontoneous moy furtherheightenthis clorificotion porticulorly thoseclients with poor ego strenglh, thosewith self-esteem for risk, issues lhosewith ooronoidlendencies. or . Cross the risk misunderstonding.o of lf cullurolcommunicolionmoy increose lhe to compromise client'sneedsit moy be is lheropy process likely significontly if or beller to nol storton the engogemenl.Similorly on ossessment consultoiion psychology or noiure needscorefulinterpretotion of on industriol-orgonisotionol shouldbe moy orise, core lo mitigotesuchrisk consequences significoni exercised. issues 3. Boundory . Thereducedcuesmoy increose likelihood the clientimposing fontosy or the of This on lronsference to o lheropeuticrelotionship. moy requireodditionolskill on lo theseissues ond to moinlointheropeulic lhe port of the psychologist oddress boundories. . Extro lo core moy be needed to mointoincleor ond predictobleboundories lhe theropeuiicrelotionship. . Texting formolond shortened expressions moy elicitless ond emoil responses which moy corryo risk erodingboundories. of . Clients os moy be more prone to "over disclose", lhe normolchecksond moy hove o disinhibiiing effect or boloncesin formingtruslore not there.This defences. in breokdownin psychologicol moy result on unheolthy olternotely reloled to time 4. lssues . Unexpectedor unforeseen time deloysmoy leod the clientlo speculoieoboul onxiety. lhe meoningof the deloy or increose . Deloymoy occur through lechnology foiling the Internet being not the or with shouldbe plonned for prooctively, ovoiloblefor o while.Suchcircumstonce o bockup plon ogreed of lhe outsel

5. Technologicol issues impoctingon professionol contocl . Cotostrophic e.9.,lhe computerhord drivemoy become equipmentfoilure, files, ond moy meon thot conioct informotion, corruptedbeyond retrievol, detoilsof clients the obilityto contoct ihem islosl. or . Messoges moy nol be received,e.9.,by being sentto the wrong oddress, by or going unnoticed,or by foilureto deliverto on overloodedmoilbox. . Confidentiolity moy be breoched,by inlernethockers by othersoccessing or the emoil occount or computer.Forexomple,ihe lottermoy occur by olher persons portners or who hove o legitimoterightto occesslhe computersuchos porents, with ownership shoredownership ihe compuier or device. of others or . Theclientmoy hove to incurextroexpense uselhe online io technology over moy orise ond ond obove whot they ore poying the psychologisl, difficulties from not being oble to offordihesechorges, exomple,runningout of credit for occess ol on theirphone,or hovingo 'copped' doto plon on iheirinlernet home. . Theclientmoy only hove portiolor restricied occess(e.9.,usingo friend's o might noi hove the ievelof computeror o cyber cofe). Likewise psychologist they mightneed or wonl, e.9..mobilephonebeingout of consistency occess of ronge of home or on weekend,no internetoccessol work elc. 6. Monogementof crises . There risks the event of ony crisis in orising which moy ihreotenthe ore increosed sofetyof eiiherlhe clientor onolherperson. . Esloblishing onlinelheropy clientidenlitymoy be difficulionline.Professionol o moy moke identifying porties the ond emergencyconloct informolion prerequisite intoke,but thismoy be difficult verify. io for 7. Legolissues . Legolond ethicolombiguityorises technologyouislrips professionol regulolion os ond guidelines. services 8. Limilotions texl bosed psychologicol of . Communicotions slower. ore . To usetexl bosed services effeclively, clieni ond psychologist boih need to hove high levelof literory skill.

3. Whatshould be done to mitigaterisk?

Giventhe ropid is for lo Thepsychologist responsible miiigotingrisks the besl of theirobility. the of evolution technology,ony guidelines Boordmoy developwould be genericrotherthon would be ociive risk ossessment The being directedto specificlypes of services. key principles into services oppropriotedelivery ond review;the need for good ossessment; chonnelling ond medio. Riskossessmenf Regordless the communicolionmediumond regordless the notureof the psychologicol of of risk to service, besl proctice requires psychologist oclivelyossess ond to remoinmindfulof o profile. moy require the psychologist reconsider to Risk mitigotion ony chongesto the risk vio clientin to whetheror not it isodvisoble deliverservices onlinelechnologyfor o porticulor theirspecificcircumstonces. Adequole ossessmenl psychologisls should cttempt to Within menlolheolthservices, including onlinecounselling, personolity thought borderline disorder, with severepsychiotric disorders, screenoui clients A shouldbe ideolion,or unmonitored medicol conditions. psychologist disorder, suicidol over the internelthroughihe mindfulthot dicgnosis ond ossessment be compromised moy limitotions the informotion on ovoiloble.

moy be: Keyquestions . How con lhe ossessment ossessment informolion omplified(e.9.,usingpsychomelric be with permission) reduce ombiguityond improve to informolion tools, seeking colloterol the quolity the formulotion? of . A fullossessment only be undertoken o foce-to-focesituotion. there Are in con which indicole the need for o foce-iofrom the ossessmenl importontdecisions orising foce meeting? r Are there specificfeoluresof lhe preseniing which couseconcern obout informotion world? the sofetyof the clientor otherpeoplein the client's Motching serviceswilh oppropriole delivery medio Keyqueslions moy be: . lsthe mediumof service likely significontly to impoct on the odequocy of the delivery or consullolion the efficocy of the inlervenlion? . Doesthe psychologisl issue for ond lo usethis hove the opproprioteskills ihispreseniing technology? . Doeslhe psychologist lo hove the necessory discipline ond troining mointoinodequote professionol services? whiledelivering onlinepsychologicol boundories . Psychoeducolion psychologicol lend lhemselves inlerveniions ond lhe useof structured Con thisservicebe deliveredin thol form? by lo service delivery the internet. . Wouldihe clientoccept referrol o foce-lo-foceservice(eilheros the primory service to likely result the clienl in or or os o supplement) would lhe wilhdrowolof onlineservice hovingno service?

4. Doesresearchevidencesupportservicedeliverythroughthe internet?
Thereseorch literoture thismode of proctice issiillof on eorlysioge of development. on thot the mediumof delivery ond context indicotes Reseorch communicolionprocesses on themselves. Reseorch on impoct on how people behove ond express does hove o significonl is usingelectronicmedio with specificdisorders ol vorying the effectiveness interventions of pockoge of utilising struciured o slogesof developmenl.Forexomple,some progrommes psycho-educotion, ond/or onlinegroup supportfor cerioin Theropy, CogniiiveBehoviour effeclive. hove been shownto be generolly specificheolthconcernsor mentol heolthissues con be delivered services Thereisless reseorch evidenceto showthot direct counselling choosingto prociisein thiswoy musttoke vio effectively the interneihowever,so psychologists greol core 1o monitorlheirworkwith individuol ond to evoluoletheirprociice.Clienis clients shouldbe informedobout ihe lock of (orlimiied)evidenceregordingthe efficocy of o intervenlion on integrolport of the informedconsenlprocess. os suggested on for Progrommes wiih littledirect input from o psychologisf, exomplethoseodvertised on with regordlo the occountobility the of open websile,roisedifferentethicolchollenges psychologisl screening for clients.

SectionB: Ethical principles

to thot the Boordmoy developwould be supplemenlory the Code of Ethics. Any guidelines which psychologicol odditionolethicolchollenges, vio Delivering services the inlernetposes sub-heodings: ore discussed underthe following o) b) c) d) e) f) S) Compelence. Informedconsent. Responsible core. Intokeprocedure. poriies. Third Confidentiolity. Recordkeeping.

h) i) j) k) l) m) n) o) p) q) r)

Triolperiod. procedures. Comploints Offeringoliernoiives. Group ethicolprinciples. Working with children. issues. Culturol Reguloloryobligolions. Avoilobility. Psychometric testing. Moinloining boundories. for Legolrisks the psychologist.

a) Competence ond A psychologist shouldhove the educotion,troining/orienlolion on-goingcontinuing for they possess necessory the competencies educotion/professionol developmentto ensure muslonly proctise in oreo. A psychologist ihe sofe provision quolilyservices iheirspeciolty of o withintheirdomoin{s) compelence ond shouldnol ottempt to deliverelecironicolly of competence in o foce-to-focesituotion. in service which they hove not demonstroled providing services throughihe internetshouldolsohove the necessory Psychologists technology competencies. is thot the intendedservice effectivewhen deliveredin lhe Compelent proclice olsorequires proclising throughthe of chosenmodolily,withinthe limilolions the technology. Psychologists on internetshouldkeep obreostof the evolvingreseorch efficoc'r. b) Informed consent ond theirservices: obout themselves Proctitioners shouldoffer comolete ond honestdisclosure in involvement whot quolificolions held,regislrotion ore slotus(ond how thiscon be verified), professionol ond theirgeogrophicollocotion. oreosof speciolty, orgonisotions, A cleor slotementshouldbe mode regordingwhot con be offeredos well os whot connol be of offered (suchos unovoilobility foce-to-foceconloct, emergencycontocl, ond psychophormocologicol referrol). services to Theclientshouldbe informedfullybefore consenting receiveonlinepsychologicol with regordto: through process the possibility misunderstondings of issues, includingocknowledging reduced visuol verbolcues,mokingexplicitlhe expected lurnoroundtime when or or on ond conloct isosynchronous, mokingexplicitony expectotions resirictions recordingor copying. the polentiolrisks ond benefilsof lhe service. being breoched,suchos by requesiing of sofeguords ogoinstlhe risk confidentiolity lo "relurnreceipt" possword moy be usedbut is more difficult set up. occess.Encryption in o suchos consulting psychologist o focethe olternotive services clieni could occess, meditotionor informotion, exercise, the of lo-foce situotion, seeking ossistonce others, doingnothing.
O a

a a

consent by proxy, where evidence should be provided lo verify the ideniity of thot p e rs o n ,e .9 ., th e p o re n l , l e gol guordi on or l egol represenl oti ve. the explicii understonding thot the professionolrelolionshipcon be ierminoied of ony sToge. h o w o c o mp l o i n t c o u l d b e l odged, shoul d thot become rel evont. ihe chorges for servicesconducled eleclronicolly. Feespoyoble should be clorified ond ogreed ol the slort of the professionolengogemenl.

shouldthere be o breokdownin on olternotemeonsof contoctingthe psychologist, meonsof communicolion. electronic

priorto signing conlroct or psychologists providewrilieninformotion o to Bestprociice requires boundories of clorifying termsof engogementwith o client.Theestoblishment professionol lhe A of ond between lhe psychologist the clientiscommunicotedby the formolity orrongements.

relotionship wrilteninformolion sheel ond signedconsentform help to definethe professionol befweenthe clientond the psychologist. ond the boundories c) Responsible care requesting o firsl. shouldconsider A prospective clientshouldbe ossessed Thepsychologist from the foce-lo-foceossessment,need be vio proxy,shouldthereexistony concernsorising if of initiol ossessment obout the suitobility thisopprooch for o client. evidenceProctilioners urged to provideo soundcourseof oction bosed on best-proclice. ore service odopted to clienl need, tokinginto occount resirictions bosed sfondords professionol of of or limilotions ovoilobleresources. lhen lhe proclitioner should different, uses opprooch thot issignificontly on lf the psychologist plonsfor the considered for in documeni the reosons thot voriotion the clientrecord.Corefully professionol with colleogues supervisor moy help or intervention demonslroling consultotion in document "thoughifulprofessionolism"the evenl of on odverseevenl. roulinely. be should undedoken Reosonoble monitoring ond outcomeossessment d) Intake procedure os Theintokeproceduremoy requireon odditionollevelof scruiiny, compored lo foce-to-foce copoble of usingonline emotionolly ond physicolly to services, ensureclientsore intellectuolly, to shouldbe screenedoul ond re-redirecled more Those who ore deemed unsuitoble services. opproprioleservices. issue suiloblefor internetossessment ore whetheror not the clientond preseniing Thedecision thot: to mcy requirethe psychologist ensure ond intervention . . . . . ond sofiwore, os including to dote equipment up Theclienthosoccess technology, to to wellos the finonces runlhis. skills reodingond comprehension io enoblethisopprooch. Theclienthosthe longuoge, clienl. is competent to work wiih thot porticulor Thepsychologist culturolly Theservice occessible is ond enoblingfor o clientwilh disobility. poor reolitytesting from o psychiotric conditionwhich includes Theclientdoes not suffer impoirment. or cognitive

processes be to by Theintokeprocedureshouldprooctivelymitigotepotentiolrisk formuloting The should ond misunderstonding unovoilobility. psychologisl followedin ihe evenl of crisis, who troinedprofessionol con providelocol qssistonce, oltempt to identifyon oppropriotely shouldexplointo clientshow to cope with if includingcrisis intervention, needed. Psychologists potentiolmisunderstondings ond exploinollernotivemodesof when visuol cuesdo nol exist if foils. communicotion technology e) Third parties muslcleody deliveredby electronicmeons,proctitioners lf third porties ore billedfor services occurredin vivo thot the interoction form.lf o ihird porty wos misled indicotethot on the billing then os comporedlo electronicolly, thot could omountlo froud. f) Confidentiality of shouldbe developed ond providedto clienls A stotementon the limitotions confidenliolity on relotionship. shouldincludereferenceto ony constroints This of the slortof the professionol relolionship ond olsolhe specificprivocy inherentin the professionol os confidentiolily normolly or Thereiso possibility inierception misdirection of from lhe electroniclronsmission. issues orising of inlernetlronsmission. Theremoy be of over lhe internet. Theremoy be less controlof the confidentiolity informotion or deliberoteor inodvertenleovesdropping emoilsmoy be reod by people olher thon lhe is moy not be oble lo verifythot o response from the client intendedrecipienl. Thepsychologist

vio discussed to to disclose o thirdporty by referring moteriolpreviously or moy inodvertently emoil. mustioke porticulor ihe of Becouse lhe eose of tronsfer electronicmoteriol, psychologist of relolionships. of core lo promoie confidenliolity interneicounselling g) Record keeping those rightto occess records ond the clienl's obout keeping Theusuol lowsond regulotions lhroughthe internetos much os to foce-toservices delivered recordsopply to psychology psychometric results, oudio/videosession test foce contoci. Clientrecordsmoy includeemoils, lf communicotions. the recordsinclude noiesond psychologist/supervisor session recordings, lhe clientshould informed. be with of recordings communicoiions the clienl, to for Recordkeepingshouldincludeprovision bock-upstorogeto meet legol obligoiions keep psychologisls lhe recordsremoin mustensure lf recordsfor 10yeorsa. kept electronicolly, odvonces. os occessible technology h) Trial period moy offer o triolperiodto ollow the clientto delerminewhetherihisiso useful A psychologist moy odvise for vio lf service. counselling ihe internetisnot suitoble thot client,the psychologist chonnels. how to seekoppropriotecore lhroughmore trodilionol i) Complaints procedures Poienliolclients shouldbe informedhow o complointcon be mode os port of the rouline sheetsuppliedol the This informedconsentprocess. shouldbe includedin ony informolion relotionship. beginningof lhe professionol j) Offering alternatives shouldhelp the clienl locote free public occesspointsto When opproprioie,the psychologist resources. ond inslructionol the internetfor informotion k) Group ethical principles the is os sense not possible occessisuncontrolled, Althoughgroup theropyin the troditionol to internetos o communicotionmediumlendsitself group forumsbul thesepose odditioncl ethicolchollenges. moy hove fo o or coordinotor, reseorcher psychologisi lf porticipoting on expert,consultont, os role hove occessto eorlier would not necessorily definelheir roleos new-comers conslontly to messoge discloimer clorify use (e.g.,ihe psychologist moy routinely o signoture definitions shouldnot be confused thisisofferedos odvice or educolion ond thol thiscommunicotion joiners could be io lf wilh mentol heolthtreotment). subscribers the group ore known,individuol olertedto the foct it iso publicforumond nol o privotethercpeuiicrelolionship. il io lf the group contextollowsindividuols forwordquestions, shouldbe mode explicitthoi such ore ond response mode public,to ovoid questions con only be occepted if bolh the queslion The theropeuticrelotionship. psychologist creolingo reol or perceivedpersonol inodvertenily to or the constroints limilotions ony suchodvice. stoling includeo discloimer should l) Working with children for services young people hove been shownto be Somementol heolthtelecommunicolion with youth culture becouseof lheir compotibility occessible both effectiveond porticulorly lhol estoblishes lf ond crisis services).the psychologisi (e.g., help lines telephone ond internel There of o porenl or guordionwould be sought. o clienl iso minorit isoptimolthot consent problem. due wherethisisnot possible lo lhe notureof the presenting moy be circumstonces oroundthe young personmoy be on importontport of supportservices ldentifying reol-world ony lheropeuticintervention.

6 l no c c o r d o n ce with He o lih ( Re te n tio no f H eol th Informol i on) R egul oti ons1995

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m) Culturalissues who in by moy The needforcullurol compelence be heighlened clienls moycommunicote

Locol or live differentlonguoges, in differenltime zones, hove uniqueculturolperspeciives. to borriers receivingfoce-io-foce ond evenlsmoy impoci on the client.Culturol conditions more oitroctivefor someclients. moy moke onlinepsychology services n) Regulatory obligations oll shouldreviewcorefully relevont Beforeemborkingon workwith o client,the procliiioner jurisdiction wellos those guidelines, codesof elhicsor conduct in the client's os legislotion, ond jurisdiction residence. shouldpoy porficulor pertoining lhe psychologist's Theproctitioner of to ond record keeping ottentionto locol cusloms(e.9.,oge of consent,child obusereporting, ond legolly. internetpsychologicol services conducted ethicolly ore requirements) ensure to lo of websiteshouldprovidelinks websiles oll oppropriole Theinternetpsychologist's proiection. boordsto focilitoteconsumer boordsond licensure certificotion where doing so would lo in A psychologist shouldnot provideservices clients stotesor countries violotelocol licensure lowsor regulotions. o) Availability to lefi ond responding messoges by A psychologist shouldmoke odequote plonsfor occessing is due lo illness or clientsin electronicform duringtimesthot the psychologist unovoiloble incopocity. p) Psychometric testing tests where the electronicolly psychologicol ony Psychologists shouldnol odminisler or lechniquesof risk would violoteony would pui the security the ossessmenl of odminislrotion lf copyrightrestrictions.o copyrighledtesl is not qvoiloblein on electronicform,then it should of not be convertedto on electronicformwilhout the permission lhe publishers. in Psychometric testsusedshouldbe interpreted lhe lightof normolivedolo for the populolion lf to which the clienl belongs. the culturolideniityor geogrophicollocolion of the clientis not then thot iso constroint on known,or there ore no selsof normotivedoto for lhot populotion, the inlerpretoiion lhol test ond shouldbe sloied explicitly. of q) Maintaining boundaries siobility, ond predictobility Boundories clinicolprocticegive the theropeuticfrome slructure, in which iscommonlyo feotureof ond therebycreoie sofetyfor the emolionoldisclosure by Boundories esloblished ore communicotionbetween the clientond ihe psychologisi. loking core to informedconsent, odherenceto the ogreed controct,ond the psychologist even if the Thepsychologisi shouldovoid usinginformolcommunicolions, ovoid duol roles. Psychologisis shouldmointointhe texlsond obbreviotions ore common in emoils. os client uses os tone someprofessionol ond longuogein emoils in the office. ond counter-lronsference Emoilcommunicotionmoy generotemore intensetronsference from uncheckedfontosies ond the orising reoclionsos compored to foce-to-focemeetings, hove providedo reolitycheck. reductionin informolive sensory dolo which moy olherwise ond moy be strippeddown to key essenliols occur in o "ropid fire" diologue. Communicotions moy chollengetheropeutic desirefor closeness An informol lone ond on unexpressed boundories. inlo ond should discussed incorporoted ony onbe Emoils olheronlinecommunicotions or ond ony processing thoi of going theropeuticprocess. Boththe electroniccommunicotions communicotionore to be retoinedos port of the clienl'srecord. r) Legal risks for the psychologist risks Onlineproclicemoy generoteodditionollegol to the psychologist:

tl

liobilityinsuronce provider to ensure their Proctitioners should consult their professionol inlended oclivity is covered prior to emborking on the octivity. ldeolly lhis should be in writing. Psychologisls should consider the wider implicolions of deoling wilh unsolicitedemoils seeking odvice. Forexomple, professionolodvice (even without o fee) moy be held to estoblisho psychologist-clienlrelotionshipond o duty of core when it is foreseeoble lhoi th e c l i e n l w i l l fo l l o w th o l o dvi ce. Advertisingon o website moy be considered lo offer on explicil worronty in on iniervenlion developed on ihe strength of it. Psychologists moy be held occountoble for diognoses ond treqtmenis bosed on insufficientor misleoding informotion. compeience or stondords Emoilsconstitute written records thot con be used to ossess of core. It moy be difficult 1o estoblishthe fees for service,given lhe difficulty of estimoiing or overseeing the iime spent on elecironic communicotions. The obsence of oversight ond slondords moy moke it difficult for the client to gouge lhe foirnessof o fee or to compore rotes ocross psychologists. It is not possiblelo onticipole the potentiol securitybreoches thot moy orise from using telecommunicotions 1o deliver confidentiol services.Precoutionory principlesshould be followed, with full use of computer security meosures.

Section C: Dealing with emergencies

musibe inlervention services bockup or crisis Plonning emergencycommunity-bosed for ond in odvonce, to ovoid o theropeuticvocuum or lock of sofetynet, underiokenroulinely shouldthe need orise. (ond recordtheirname Thepsychologist shouldseekcl the outseto locol heolthproctilioner the os number) who preferobly olreodyknows clienl(such theirGP)ond who ond lelephone to could be referred in emergency. theirpublicsofetydutiesby being ore enobled to dischorge Psychologisis normolly pertoining theirjurisdiction, for os to ond procedures knowledgeoble the lows,oulhorities, of in when lhere iso risk horm to lhe clientor others lhe client'sworld. Theyolso of exomple this to However isunlikely opply with key personnel. ond developworkingrelolionships neiworks withinthe internetcullureindividuols Furf if o psychologist workinginternotionolly. hermore, is moy noi hove the Therefore psychologist often usecode nomesor moinloinononymily. con locote lhe person ond sociolresources occurole detoilsto reportso thot locol ouihorities orising from to Thepsychologist shouldmoke extroefforts offsetlhe risks orise. shouldo crisis theseootentiolscenorios. os wilh cleorwritleninstructions fo whot lo do in on Prcctitioners shouldprovideoll clienls in theseorrongements their risk) ond to discuss emergency(e.g.,where lhere isc suicide suoervision. to os willdifferoverjurisdiclions, willobligotions third Lowswilh regord to mondotoryreporting porties protecl from horm.Psychologists with the relevontlows themselves shouldfomiliorise lo ore living). where theirclients in in ony jurisdiction which they ore working(i.e.,

Section D: Other related r'ssues

ond privocy throughthe inlernelisolleringihe boundories of Thereody ovoilobility informotion ond client. of both psychologist on becoming occessible the Whot moy hove been privoteconduct in ihe post isincreosingly on informotion oboul psychologists moy seekpersonol inlernet, ond thereforepublic.Clienis life between the professionol of the This the internet. chongesthe nolureof lhe division
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psychologist omountsof informotion obout individuol ond theirprivolelife.Increosing psychologisls troinees including blogging, ond moy be ovoiloble online, dotingbehoviour, or references professionol lo octiviiy. oboul their Thereore ethicolimplicotions orising from o psychologisl checkingfor informotion hintsof suicidol inclinotions or the internel, including exomple,possible for clienl on Acting on informoiion thot the personhos not provided dysfunctionol doting behoviour. privocyond ouionomy. with direcllymoy be inconsislent o respeclfor ihe individuol's Acodemic psychologists thoseinvolvedin troiningmoy wish1oscreenoppliconisfor o or professionol psychology lheir nome on ihe internel. troiningcourseby seorching lroinees'oworeness lhe poientiolimpocl on theirwork if they of Lecturers moy wish1oincreose postdoto oboul themselves onlinechot roomsor Focebook, bui moy be reluclontto odmit on in to reseorching lhe nei, or be reluclontto be undulyintrusive theirlives. on is is lf informotion obtoined obout o clientor o colleogueond ihot informotion ihen usedos o ond for the shoulddeclorelhe sourceof thot informotion bosis decision-moking, psychologisl give the client,siudent,or colleogueon opportunily correctony inoccurocies to ond/or io io methodsond the opportunity speoklo the disclosure ossessment of discuss contenl. Full processes essentiol tronsporency ore for ond noluroljustice. concernsroisedby ossessment

Section E: Consumerguide
ogoinslseeking Boordneitherpromotesnor odvises TheNew ZeolondPsychologists psychologicol lhe ony userof services throughlhe inlernet.However, Boordencouroges given the relotive psychology services deliveredthroughthe internelto proceed coutiously, lock of reseorch evidence on lhe efficocyond sofeiyof someservices. guidelines lhot: moy includeo cleorstolemeni Consumer . Foce-to-foce preferred melhod bul it shouldolsobe counselling the trodilionolly is opprooch of ocknowledgedthot onlinecommunicotionmedio moy be lhe preferred someclienis. . Consumers shouldexpect on equivolent stondordof core to thot deliveredin o more troditionol selling. . Consumers reseorch ihe effectiveness of on shouldbe informedlhot there isless psychologicol services deliveredlhroughthe internet. . Consumers shouldbe odvisedhow lo proceed with o complointshouldthot become relevont. . Consumers if is shouldbe olertedto the focl thol thereisno recourse the psychologist unidentified out of reoch of lhe Bocrd. or unreguloted, . Fees credil cord informolion. shouldbe discussed ond ogreed beforesupplying . Thepsychologist ond guidoncewith regord1oemergency shouldprovideinformotion services. Clients could olsobe odvisedlo: . be honestobout theirideniitv,locolionond noiureof problemor concerns. . know whot they hove ogreed to poy. . be owore of the limits internelcounselling. of . oskqueslions onytime, ond especiolly the beginning. of . obtointhe psychologist's lelephonenumber. . odvisehow lhe psychologist when colling. shouldidentifyhim or herself . be owore of lheir righls o consumer ond proceed couliously. os

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