Çevrimiçi Psikoterapinin Etik Kodlar Çerçevesinde İncelenmesi

Giderek yaygınlaşan, gelişen ve değişen teknolojinin bir sonucu olarak kişilerin iletişim ve etkileşim kurma yolları da zaman içinde değişime uğramış, hayatımızın bu derece kaçınılmaz bir parçası haline gelen internet kullanımı, artan bir şekilde “psikoterapi hizmeti de internet üzerinden uygulanabilir mi?’ sorusunu beraberinde getirmiştir. Aynı zamanda çevrimiçi psikoterapinin etkililiğine dair şüpheler, terapötik ittifakın kurulamaması endişesi, teknolojik alt yapı yetersizliği, gizlilik, güvenlik ve etik sorunlar ise bu alandaki gelişmelerin önünde ciddi bir engel oluşturmaktadır. Bu çalışmanın amacı da çevrimiçi yürütülen psikoterapilerde yaşanabilecek, en çok kaygı uyandırdığı alanyazında tespit edilen durumlar karşısında, terapistlerin öngörülerinin etik kodlar çerçevesinde incelenmesidir. Araştırmaya, Türkiye’nin farklı illerinde çalışan 43 psikoterapist katılmıştır. Çevrimiçi psikoterapi sürecinde hipotetik durumlar aracılığıyla terapistlerin tepkilerinin açığa çıkarılması hedeflenmiş, elde edilen veriler ‘tümevarımsal tematik analiz’ (inductive thematic analysis) prosedürü kullanılarak analiz edilmiştir. Araştırmada katılımcıların hipotetik durumda ne yapacaklarına ilişkin yanıtları ‘tepkiler’; bu tepkileri verirken yaptıkları açıklamaları ise terapist olarak ‘görüşleri’ olarak kavramsallaştırılmıştır. Tepkilere ilişkin elde edilen bulguların çevrimiçi psikoterapide (1) Sorumluluk alanının kontrolünü kaybetmek, (2) Sürecinin kontrolden çıkması durumunda başa çıkma, (3) Yetkinliğin sınırlarını korumak (4) Sözel olmayan ipuçlarını kaçırabilme durumuyla başa çıkma ve (5) ‘Kırmızı çizgi’: Çevrimiçi terapiyi tercih etmemek şeklinde 5 temada gruplandırılabileceğine karar verilmiştir. Görüşlere ilişkin elde edilen bulgular göz önünde bulundurulduğunda, bir uçta çevrimiçi terapilerin tamamen etik dışı olduğu, diğer uçta çevrimiçi terapileri kullanmamanın etik dışı olduğu görüşlerinin bir boyut üzerinde yer aldığı görülmüştür. Ortaya çıkan bu temalar Türk Psikologlar Derneği Etik Yönetmeliği referans alınarak tartışılmış, terapistlerin durum karşısındaki tepkileri incelenirken etik yönetmelikteki maddelerin içeriğine dair ihtiyaçlar ve çözüm önerileri belirlenmiştir.

Investigating Online Psychotherapy in the Framework of Ethical Codes

The ways people communicate and interact have been changing over time as a result of the increasingly widespread developments and changes in technology. The use of the Internet, which has become an inevitable part of human life, increasingly raises the question of whether psychotherapy can be performed over the Internet. At the same time, doubts about the effectiveness of online psychotherapy; worries about not being able to establish a therapeutic alliance; the lack of technological infrastructure, privacy, and security; and ethical problems pose serious obstacles to the developments in this field. The aim of this study is to examine therapists’ reactions to unexpected situations that occur in the literature within the framework of ethical codes and that are found to be the most concerning to therapists regarding online psychotherapy. This study’s participants involve 43 therapists working in different provinces of Türkiye. The study examines online psychotherapy with the aim of revealing psychotherapists’ perceptions with regard to hypothetical situations and analyzes the obtained data according to the qualitive analytical method of inductive thematic analysis. The findings can be grouped under five themes: (1) how to not lose control of the area of responsibility, (2) how to cope with out-of-control situations, (3) how to maintain the limits of competence, (4) how to cope with the lack of nonverbal cues, and (5) a red line not to be crossed (i.e., these participants do not prefer online therapy). When considering the findings regarding their views, they are seen to range from online therapy being considered completely unethical at one extreme and unethical not to use online therapies at the other. The study discusses these emerging themes with reference to the Code of Ethics of the Turkish Psychologists Association while also analyzing therapists’ reactions to the situations and determining the needs for and resolving which items should be present in the code of ethics.

___

  • Alleman, J. R. (2002). Online counseling: The internet and mental health treatment. Psychotherapy: Theory, Research, Practice, Training, 39(2), 199. http://dx.doi.org/10.1037/0033-3204.39.2.199 google scholar
  • Amante, D. J., Hogan, T. P., Pagoto, S. L., English, T. M. ve Lapane, K. L. (2015). Access to care and use of the Internet to search for health information: Results from the US National Health Interview Survey. Journal of medical Internet research, 17(4), e106. https://doi.org/10.2196/jmir.4126 google scholar
  • Bal, U., Yılmaz, E., Tamam, L. ve Çakmak, S. (2015). Telepsikiyatri: Şimdi ve burada. Psikiyatride Güncel Yaklaşımlar, 7(2), 136-148. google scholar
  • Barak, A., Klein, B. ve Proudfoot, J. G. (2009). Defining internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38(1), 4-17. https://doi.org/10.1007/s12160-009-9130-7 google scholar
  • Bekes, V. ve Aafjes-van Doorn, K. (2020). Psychotherapists’ attitudes toward online therapy during the COVID-19 pandemic. Journal of Psychotherapy Integration, 30(2), 238. http://dx.doi.org/10.1037/ int0000214 google scholar
  • Bekes, V, Aafjes-van Doorn, K., McCollum, J., Prout, T. R. ve Hoffman, L. (2022). The development of a self-report scale to assess therapists’ acceptance of telepsychotherapy. Journal of Clinical Psychology, 78(6), 1240-1260. https://doi.org/10.1002/jclp.23289 google scholar
  • Braun, V. ve Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa google scholar
  • Childress, C. A. (2000). Ethical issues in providing online psychotherapeutic interventions. Journal of Medical Internet Research, 2(1), e5. https://doi.org/10.2196/jmir.2.1.e5 google scholar
  • Chung-Do, J., Helm, S., Fukuda, M., Alicata, D., Nishimura, S. ve Else, I. (2012). Rural mental health: Implications for telepsychiatry in clinical service, workforce development, and organizational capacity. Telemedicine and e-Health, 18(3), 244-246. https://doi.org/10.1089/tmj.2011.0107 google scholar
  • Cook, J. E. ve Doyle, C. (2002). Working alliance in online therapy as compared to face-to-face therapy: Preliminary results. CyberPsychology & Behavior, 5(2), 95-105. https://doi. org/10.1089/109493102753770480 google scholar
  • Dörfler, V. ve Stierand, M. (2021). Bracketing: A phenomenological theory applied through transpersonal reflexivity. Journal of Organizational Change Management, 34(4), 778-793. https:// doi.org/10.1108/JOCM-12-2019-0393 google scholar
  • Fantus, S. ve Mischna, F. (2013). The ethical and clinical implications of utilizing cybercommunication in face-to-face therapy. Smith College Studies in Social Work. 83(4):466-80. https://doi.org/10.10 80/00377317.2013.833049 google scholar
  • Fereday, J. ve Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5(1): 80-92. https://doi.org/10.1177/160940690600500107 google scholar
  • Finfgeld, D. L. (2000). Therapeutic groups online: The good, the bad, and the unknown. Issues in Mental Health Nursing, 21(3), 241-255. https://doi.org/10.1080/016128400248068 google scholar
  • Finlay, L. (2002). “Outing” the researcher: The provenance, process, and practice ofreflexivity. Qualitative Health Research, 12(4), 531-545. https://doi.org/10.1177/104973202129120052 google scholar
  • Fischer, C. T. (2009). Bracketing in qualitative research: Conceptual and practical matters, Psychotherapy Research, 19(4-5), 583-590. Doi: 10.1080/10503300902798375 google scholar
  • Fortney, J. C., Pyne, J. M., Turner, E. E., Farris, K. M., Normoyle, T. M., Avery, M. D., Hilty, D. M. ve Unützer, J. (2015). Telepsychiatry integration of mental health services into rural primary care settings. International Review of Psychiatry, 27(6), 525-539. https://doi.org/10.3109/09540261.2015.1085838 google scholar
  • Fussell, S. R. (1995). Social and cognitive processes in interpersonal communication: Implications for advanced telecommunications technologies. Human Factors, 37(2), 228-250. https://doi. org/10.1518%2F001872095779064546 google scholar
  • Geller, S. (2021). Cultivating online therapeutic presence: Strengthening therapeutic relationships in teletherapy sessions. Counselling Psychology Quarterly, 34(3-4), 687-703. https://doi.org/10.1080 /09515070.2020.1787348 google scholar
  • Germain, V., Marchand, A., Bouchard, S., Guay, S. ve Drouin, M. S. (2010). Assessment of the therapeutic alliance in face-to-face or videoconference treatment for posttraumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 13(1), 29-35. https://doi. org/10.1089=cyber.2009.0139 google scholar
  • Gowen, K., Deschaine, M., Gruttadara, D. ve Markey, D. (2012). Young adults with mental health conditions and social networking websites: Seeking tools to build community. Psychiatric Rehabilitation Journal, 35(3), 245-250. https://doi.org/10.2975/35.3.2012.245.250 google scholar
  • Griffiths, M. ve Cooper, G. (2003). Online therapy: Implications for problem gamblers and clinicians. British Journal of Guidance and Counselling, 31(1), 113-135. https://doi.org/10.1080 /0306988031000086206 google scholar
  • Grigsby, J., Rigby, M., Hiemstra, A., House, M., Olsson, S. ve Whitten, P. (2002). Chapter 7: The diffusion of telemedicine. Telemedicine Journal and e-health, 8(1), 79-94. google scholar
  • Grubbs, K. M., Fortney, J. C., Dean, T., Williams, J. S. ve Godleski, L. (2015). A comparison of mental health diagnoses treated via interactive video and face to face in the Veterans Healthcare Administration. Telemedicine and e-Health, 21(7), 564-566. https://doi.org/10.1089/tmj.2014.0152 google scholar
  • Haberstroh, S., Parr, G., Bradley, L., Morgan-Fleming, B. ve Gee, R. (2008). Facilitating online counseling: Perspectives from counselors in training. Journal of Counseling ve Development, 86(4), 460-470. https://doi.org/10.1002/j.1556-6678.2008.tb00534.x google scholar
  • Hanley, T. (2021). Researching online counselling and psychotherapy: The past, the present and the future. Counselling and Psychotherapy Research, 21(3), 493-497. https://doi.org/10.1002/ capr.12385 google scholar
  • Hatfield, D. R. ve Ogles, B. M. (2004). The use of outcome measures by psychologists in clinical practice. Professional Psychology: Research and Practice, 35(5), 485-491. https://doi. org/10.1037/07357028.35.5.485. google scholar
  • Heinlen, K. T., Welfel, E. R., Richmond, E. N. ve Rak, C. F. (2003). The scope of WebCounseling: A survey of services and compliance with NBCC Standards for the ethical practice of WebCounseling. Journal of Counseling & Development. 81 (1):61-9. https://doi.Org/10.1002/j.1556-6678.2003. tb00226.x google scholar
  • Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J. ve Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Telemedicine and e-Health, 19(6), 444-454. https://doi.org/10.1089/tmj.2013.0075 google scholar
  • Ignatowicz, A., Atherton, H., Bernstein, C. J., Bryce, C., Court, R., Sturt, J. ve Griffiths, F. (2019). Internet videoconferencing for patient-clinician consultations in long-term conditions: A review of reviews and applications in line with guidelines and recommendations. Digital Health, 5, 1-27. https://doi.org/10.1177/2055207619845831 google scholar
  • Korkmaz, B. ve Şen, G. (2018). Psikoterapistlerin çevrimiçi yürütülen psikoterapilere yönelik algılarına ilişkin bir tematik analiz çalışması. Klinik Psikoloji Dergisi, 2(3), 140-152. https://doi. org/10.31828/kpd2602443829092018m000004 google scholar Lambert, M. J. ve Hawkins, E. J. (2004). Measuring outcome in professional practice: Considerations in selecting and using brief outcome instruments. Professional Psychology: Research and Practice, 35(5), 492-499. https://doi.Org/10.1037/0735-7028.35.5.492 google scholar
  • Lazard, L. ve McAvoy, J. (2020). Doing reflexivity in psychological research: What’s the point? What’s the practice? Qualitative Research in Psychology, 17(2), 159-177. https://doi.org/10.1080/147808 87.2017.1400144 google scholar
  • Mair, F. ve Whitten, P. (2000). Systematic review of studies of patient satisfaction with telemedicine. BMJ, 320(7248), 1517-1520. https://doi.org/10.1136/bmj.320.7248.1517 google scholar
  • Malhotra, S., Chakrabarti, S. ve Shah, R. (2013). Telepsychiatry: Promise, potential, and challenges. Indian Journal of Psychiatry, 55(1), 3-11. https://doi.org/10.4103/0019-5545.105499 google scholar
  • Manhal-Baugus, M. (2001). E-therapy: Practical, ethical, and legal issues. CyberPsychology & Behavior, 4(5), 551-563. https://doi.org/10.1089/109493101753235142 google scholar
  • Miller, B. J., Stewart, A., Schrimsher, J., Peeples, D. ve Buckley, P. F. (2015). How connected are people with schizophrenia? Cell phone, computer, email, and social media use. Psychiatry Research, 225(3), 458-463. https://doi.org/10.1016/j.psychres.2014.11.067 google scholar
  • Mora, L., Nevid, J. ve Chaplin, W. (2008). Psychologist treatment recommendations for Internetbased thera-peutic interventions. Computers in Human Behavior, 24(6), 3052-3062. https://doi. org/10.1016/j.chb.2008.05.011 google scholar
  • Naslund, J. A., Grande, S. W., Aschbrenner, K. A. ve Elwyn, G. (2014). Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube. PLOS One, 9(10), e110171. https://doi.org/10.1371/journal.pone.0110171 google scholar
  • Rabinowitz, T., Murphy, K. M., Amour, J. L., Ricci, M. A., Caputo, M. P. ve Newhouse, P. A. (2010). Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemedicine and e-Health, 16(1), 34-40. Doi: 10.1089/tmj.2009.0088 google scholar
  • Rathenau, S., Sousa, D., Vaz, A. ve Geller, S. (2021). The effect of attitudes toward online therapy and the difficulties perceived in online therapeutic presence. Journal of Psychotherapy Integration. Advance Online Publication. https://doi.org/10.1037/int0000266 google scholar
  • Rochlen, A. B., Zack, J. S. ve Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60(3), 269-283. https://doi. org/10.1002/jclp.10263 google scholar
  • Rummell, C. M. ve Joyce, N. R. (2010). “So wat do u want to wrk on 2day?”: The ethical implications of online counseling. Ethics & Behavior, 20(6), 482-496. https://doi.org/10.1080/10508422.2010 .521450 google scholar
  • Schröder, J., Berger, T., Meyer, B., Lutz, W., Hautzinger, M., Späth, C., Eichenberg, C., Klein, J. P. ve Moritz, S. (2017). Attitudes towards internet interventions among psychotherapists and individuals with mild to moderate depression symptoms. Cognitive Therapy and Research, 41(5), 745-756. https://doi.org/10.1007/s10608-017-9850-0 google scholar
  • Schulze, N., Reuter, S. C., Kuchler, I., Reinke, B., Hinkelmann, L., Stöckigt, S., Siemoneit, H. ve Tonn, P. (2019). Differences in attitudes toward online interventions in psychiatry and psychotherapy between health care professionals and nonprofessionals: A survey. Telemedicine and e-Health. https://doi.org/10.1089/tmj.2018.0225 google scholar
  • Shaw, H. E., ve Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling and Development, 84, 41-53. https://doi.org/10.1002/j.1556-6678.2006.tb00378.x google scholar
  • Shore, J. H. ve Manson, S. M. (2005). A developmental model for rural telepsychiatry. Psychiatric Services, 56(8), 976-980. https://doi.org/10.1176/appi.ps.56.8.976 google scholar
  • Simpson, J., Doze, S., Urness, D., Hailey, D. ve Jacobs, P. (2001). Telepsychiatry as a routine service-the perspective of the patient. Journal of Telemedicine and Telecare, 7(3), 155-160. https://doi. org/10.1258%2F1357633011936318 google scholar
  • Stoll, J., Müller, J. A., ve Trachsel, M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in Psychiatry, 10, 993. https://doi.org/10.3389/fpsyt.2019.00993 google scholar
  • Sucala, M., Schnur, J. B., Brackman, E. H., Constantino, M. J., ve Montgomery, G. H. (2013). Clinicians’ attitudes toward therapeutic alliance in E-therapy. The Journal of General Psychology, 140(4), 282293. https://doi.org/10.1080/00221309.2013.83059 google scholar
  • Tanrıkulu, İ. (2009). Counselors in training students’ attitudes towards online counseling. Procedia Social and Behavioral Sciences, 1(1), 785-788. google scholar
  • Türk Psikologlar Derneği (TPD). (2004). Türk Psikologlar Derneği etik yönetmeliği. Erişim adresi: http://am.org /iupsys/ethics/turkey-code-turkish.pdf. Erişim tarihi: 15.07.2020. google scholar
  • Türk Psikologlar Derneği (TPD). (2020). Çevirimiçi psikolojik müdahale ve uygulamalar için telepsikoloji kılavuzu. Erişim adresi: https://www.psikolog.org.tr/tr/files/folder/telepsikoloji-kilavuzu-x150.pdf google scholar
  • Vahia, I. V., Ng, B., Camacho, A., Cardenas, V., Cherner, M., Depp, C. A., Palmer, B. W., Jeste, D. P. ve Agha, Z. (2015). Telepsychiatry for neurocognitive testing in older rural Latino adults. The American Journal of Geriatric Psychiatry, 23(7), 666-670. https://doi.org/10.1016/j.jagp.2014.08.006 google scholar
  • Wangberg, S. C., Gammon, D. ve Spitznogle, K. (2007). In the eyes of the beholder: Exploring psychologists’ attitudes towards and use of e-therapy in Norway. Cyberpsychology & Behavior, 10, 418-423. https://doi.org/10.1089/cpb.2006.9937 google scholar
  • Weinberg, H. (2020). Online group psychotherapy: Challenges and possibilities during COVID-19—A practice review. Group Dynamics: Theory, Research, and Practice, 24(3), 201. http://dx.doi. org/10.1037/gdn0000140 google scholar
  • Willig, C. (2013). Introducing qualitative research in psychology. McGraw-Hill. google scholar
  • Yorulmaz, O., Sapmaz-Yurtsever, S., Gökdag, C., Kaçar Basaran, S., Göcek-Yorulmaz, E., Yalçin, M. ve Görgü-Akçay, N. S. (2018). The future of pychotherapy in Turkey: Predictions for the next 10 years. The Journal of Nervous and Mental Disease, 206(5), 332-339. http://dx.doi.org/10.1097/ NMD.0000000000000797 google scholar
  • Zeren, Ş. G. (2014). Information and communication technology in education of psychological counselors in training. International Online Journal of Educational Sciences, 6(2), 494-509. http:// dx.doi.org/10.15345/iojes.2014.02.019 google scholar
  • Zeren, Ş. G. (2015). Face-to-Face and online counseling: Client problems and satisfaction. Education and Science, 40(182), 127-141. google scholar
  • Zeren, Ş. G. (2017). Therapeutic alliance in face-to-face and online counseling: Opinions of counselor candidates. Journal of Human Sciences, 14(3), 2278-2307. google scholar
  • Zeren, Ş. G. ve Bulut, E. (2018). Çevrimiçi psikolojik danışmada etik ve standartlar: Bir model önerisi. Türk Psikolojik Danışma ve Rehberlik Dergisi, 8(49), 63-80. google scholar