Michael Pennington, Rikki Patton, Heather Katafiasz, Amber Fensler

Introduction
Technology is an ever expanding part of our daily lives and a
promising and rapidly spreading aspect of therapy. Research
has reported several advantages to using technology in
therapy:
•  Online therapy has shown it to be as effective as face-to-face
therapy in the treatment of depression and panic
disorder1,2,3.
•  Online therapy may also be a helpful tool for counseling in
rural areas and for therapists with hectic schedules2,4.
•  Text messaging in counseling has been shown to be effective
for enriching their communication5,6.
•  E-mail along with text messaging has been shown to be
effective at reducing symptomatic behaviors of eating
disorders5,7.
The literature has suggested that many of the ethical
dilemmas surrounding technology in therapy have begun to be
resolved over time2,8.
However, there are still lingering questions on how to most
effectively and ethically use technology as part of the
therapeutic process on areas including, but not limited to2:
•  confidentiality
•  licensing and liability
•  issues for crises situations
•  education and training
•  the impact on the therapeutic relationship.
While the revised 2015 AAMFT code of ethics has attempted to
address many of these ethical areas and most state licensure
boards also address technology, preliminary reviews of various
state laws/rules, as well as national and international codes of
ethics indicate a potential lack in comprehensive guidelines for
clinicians.
Michael Pennington, Rikki Patton, Heather Katafiasz, Amber Fensler
Method
Data sources:
•  Codes of Ethics: AAMFT, ACA and IAMFC
•  State documents: Rules and Regulations from each U.S.
State
Procedure and Data Analysis Steps:
1.  The research team developed a list technology-related key
terms.
2.  Additional key terms were identified and added to the list
based on a Google search.
•  States were not included in the analyses if rules/regulations were
unavailable or the state adopted the AAMFT code of ethics in lieu
of state specific rules/regulations: Arkansas, Connecticut,
Delaware, Florida, Idaho, Illinois, Missouri, Nevada, North
Carolina, Tennessee, Vermont, West Virginia, Wisconsin,
Wyoming
4.  Each document was randomly assigned to team members to
conduct a content analysis for key terms; a content analysis
table was created based on this analysis.
•  As new terms were identified in the analyses of the ethical codes
and state documents, they were added to the content analysis
table.
5.  A coding document was created whereby each team
member inserted each keyword (and relevant context) into
a single document for thematic analysis.
6.  Two team members conducted a preliminary thematic
analysis to examine the emergent themes regarding each
key term and overall themes the technology key terms as a
whole.
80
50
Competency
in computer
skills
40
30
20
Recording
through
electronic
means
Use of Distance
Learning or
electronic
programs
Truth &
Honesty
Documentation
requirements
10
Mandated
Reporting
Competence
Addressing
technology within
Usage of electronic
means to obtain
Registration
&
Verification
of license
0
Supervision
Continuing Education
Advertising
Supervision
License(ing)
Competence
Confidentiality
Figure 2: Technology-related key terms that were identified in the qualitative analyses.
Informed Consent
License(ing)
Addressing
technology within
Continuing
Education
Technology
3.  Ethical codes and state documents were downloaded from
relevant websites.
The purpose of the current study was to systematically examine all US state licensure laws/rules, as well as the AAMFT, ACA, and
IAMFC codes of ethics, in order to develop a more comprehensive view of how MFTs may manage technology ethically and legally in
their clinical practice.
60
Registration &
verification of license
•  4 team members: 2 faculty, 1 Masters Student, 1 Doctoral
Student
The Current Study
70
Recording through
electronic means
Informed
Consent
Documentation
requirements
Use of Distance
Learning or Electronic
Programs
Competency in
Computer Skills
Advertising
Confidentiality
Usage of electronic
means to obtain
Truth & Honesty
Mandated Reporting
Figure 1: Technology-related key terms that were identified in the qualitative
analyses.
Results and Discussion
Results showed that 6 themes and 11 subthemes emerged
from the qualitative analyses of the US state rules/regulations
and national/international ethical codes (Figure 1).
While technology is discussed throughout ethical codes and
state documents, the discussion is limited with narrow focus
that does not account for the growing trends in technology
(e.g. social media). We need more clear and comprehensive
guidelines that account for current experience of technology
Clinical Implications: Clinical settings are immersed in
technology; whether conducting e-therapy or more traditional
in-person therapy, clinicians need a better understanding of
how technology can be used, and impacts, the therapeutic
relationship, the supervisory relationship, and all other
isomorphic processes we experience in our profession so that
we ensure we are operating legally and ethically.
We are currently using technology without a clear ‘roadmap’;
future work should focus on developing and maintaining a
technology and ethics guide.