Technology in counseling began with the advent of the desktop computer over 30 years ago. Success in computer-aided services for career counseling and increased comfort with technology were factors in the computer becoming a mainstay in the therapeutic setting. Research has found that the computer enhances counseling services in the areas of testing and assessment, career decision making, intake interviewing, and personal counseling, and that it enables maintenance and storage of records in a smaller space and improves cost effectiveness. Although Internet access has provided avenues for filing insurance, advertising services, and providing e-therapy, computer-aided counseling refers to applications that are strictly accessed on a basic computer without Internet access. Expanded uses of computer-aided counseling have challenged mental health professionals to understand and take measures to ensure that all ethical standards are met.
The advantages of computer-aided counseling should not lull therapists into ignoring the ethical challenges and considerations that accompany the use of computer technology. All ethical standards that apply to traditional counseling also translate to computer-aided counseling. Further, as the uses of technology have increased, additional ethical standards have been adopted to address the specific unique challenges.
Ethical Issues in the Use of Computer-Aided Assessments
One of the fastest growing businesses within the field of psychology is that of computerized administration and interpretation of tests (e.g., the Minnesota Multiphasic Personality Inventory-2 [MMPI-2], the Millon Clinical Multiaxial Inventory [MCMI], the Myers-Briggs Type Indicator [MBTI]) resulting in the adoption of the 1986 APA Guidelines for Computer-Based Tests and Interpretations. Currently there are over 500 computerized assessments offering computerized interpretations as well. Benefits of computerized psychological tests (CPT) include that little or no supervision of the test-taker is required, little training is required to administer the test, the computer program may generate the report and interpretation, and overall costs are reduced. Other advantages of computerized tests over traditional versions are that the test-taker makes fewer errors and that fewer errors are made when scoring.
Ethical standards further address implications for the development and sales of CPTs and interpretation services. Manuals with clear statements as to the purpose of the test, instructions for administration, validity and reliability scores, and specific interpretation statements must be provided. Most recently, scoring and test interpretation services are also offered to users through mail service or through computer software packages. These services, while helpful, must be considered in light of their limitations. Interpretations must include specific information that might have influenced scoring, such as ethnicity, education, and physical disabilities. No test scoring and interpretation service should be used if validity, reliability, and specific interpretation information is lacking. It remains the user’s responsibility to use and interpret assessments appropriately, regardless of how the tests are scored and interpreted.
One option sometimes offered by automated scoring services is that of providing a copy of the computerized interpretation. Users of these automated services should first investigate to determine how results may be presented and how the client’s confidentiality will be maintained. Some services offer to provide a copy of the interpretation, but such a report should not be provided to the client without an explanation in terms understandable to the client. The explanation should include any implications and potential consequences in the future and how the results will be used.
Individuals using any type of assessment must be competent in their use. Before computerized versions of psychological tests were created, individuals without the appropriate education and training were discouraged from using such tests due to the intricacies of scoring and interpretation. The ease of computerized testing and interpretation has opened a door to misuse. The developers of computerized tests assume that the user of the test will be competent through education, training, and experience to administer, score, and interpret the results for each specific test. Ethical standards for the use of an electronic assessment include proper selection, interpretation, scoring, and administration in light of research or evidence supporting the purpose, validity, and reliability of the assessment for use with the individual to be tested. Language and cultural differences, disabilities, and familiarity with computers must be considered prior to selecting a specific electronic assessment. Although many computerized versions of the most popular assessments have been found to be psychometrically equivalent to their paper-and-pencil versions, results of research comparing the validity of traditional tests to that of CPTs have been mixed. Not only must CPT users be knowledgeable about the validity and reliability of the tests, they must also be knowledgeable regarding the computerized interpretation system as well. The computerized versions of psychological tests are to be used as enhancements to clinical interviews and knowledge of diagnostic criteria and not as the sole means of making a diagnosis.
When test administration, scoring, or interpretation is delegated to another, only individuals who are judged to have ability to conduct the tasks competently (based upon education, training, or supervision) should be given that authority. Responsibility for the appropriate use and interpretation of assessments remains with the supervising therapist regardless of how the tests are scored and interpreted.
Informed consent for any type of assessment should be obtained from the client or guardian and documented, whether consent is written or oral. A clear explanation of the nature, purpose, procedures, format, and duration of the assessment must be given. The explanation of the assessment must also include fees and potential involvement of others (e.g., law, school). If a client is to provide full informed consent, it is important that he or she understand what the assessment is to evaluate (e.g., competency, disabilities) and for what purpose the results will be used (e.g., treatment planning, custody decisions). If results are to be shared with others, the limits of confidentiality must be made clear before informed consent can be obtained. Particularly when an automated scoring service is to be used, the limits of confidentiality must be detailed.
Test Materials and Test Security
Although maintaining the security of CPTs may seem easier than maintaining the security of paper forms, manuals are also considered test materials and should be secured when not in use. Many tests are now available through the Internet but come with additional security issues. For counselors who wish to provide testing access via their own Web page to their clients, prior to taking such action, consulting with the test developer for permission is advisable. Legal consultation for the use of copyrighted materials through a Web page is also suggested.
Maintenance, Storage, and Disposal of Electronic Confidential Records
As previously stated, one of the earliest uses of computers in counseling was to maintain client records in computer files. The American Psychological Association (APA) mandates that client files must be maintained and stored under the control of the therapist. It is important in maintaining confidentiality that steps are taken to protect client identification through methods such as assigning case or code numbers regardless of where records are stored. Just as written files are kept in locked filing cabinets within locked storage rooms, electronic files must have equivalent protection.
Storage of Confidential Electronic Records
While disks can be stored in the same manner as written files, other procedures are required for maintaining confidentiality of files stored on computers. Basic security measures for individual computers with no Internet access are the use of authenticating measures (user names and passwords). For mental health organizations using a computer network with Internet access, multiple combined security measures have been identified as the most effective. The first layer of protection is using authenticating measures to limit record access to only those working with a specific client. A second layer of protection is the use of an intrusion prevention system that detects suspicious network traffic and protects the network by denying access. Encryption provides a third layer of privacy, particularly when individuals are communicating via e-mail.
Disposal of Electronic Files
Disposal of electronic files has unique problems. Simply erasing a disk or hard drive is not adequate in destroying files, as computer experts can re-create files with little difficulty. It is recommended that computer disks be physically destroyed, as even overwriting may not totally make the information unreadable. For records deleted from a computer’s files, secure file deletion utility programs are available to ensure that files cannot be recovered. When a computer must be replaced, the hard drive may be removed and physically destroyed.
Improper Use of Computer Treatment Programs and Unrealistic Expectations
A variety of computer-based psychotherapy intervention programs are now available (e.g., systematic desensitization). Used appropriately as a part of the counseling process, computer interventions have been touted as being quite effective. Ethical considerations include best practices in counseling, competency in the use of the specific intervention, and too great a reliance on the cognitive to the detriment of an exploration of the affective. Clients may also develop a belief through the instantaneous computer process that a more rapid behavior change will also occur. Information concerning length of time of therapy, including all computer-aided processes, should be explained as a part of informed consent.
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