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Beware: How Confidential Is the Information You Share With Your Therapist?

by Dr. John Riolo and Heather G. Miller, LCSW

The Chinese language is one of the world’s oldest written languages. Despite its antiquity, it has some things in common with one of the newest languages, the language of the computer. For much of Chinese history only scholar-officials, who were members of the educated class, deciphered the written language. To be a member of the scholar-elite was quite an honor since very few people were educated.... [1]

To day more and more of us are becoming familiar with computers. We use it to write, do research and communicate with each other over great distances quickly. Only a relatively few are truly familiar with the language of the computer. They are the programmers, the code writers and the hackers.

For most purposes we do not need to know too much about the technical stuff just as we can speak a language adequately but not be basically illiterate. Yet, we need to at least know what we don’t know and take proper precautions.

Recently I was having a discussion with a respected colleague, a scholar and dedicated researcher in my profession. I stated that computer literacy is so essential for social workers that it will not be long where those of us who are not computer proficient will simply be out of the loop. We will be unable to effectively practice in so many areas that in effect we will not be marketable and our educational system must take that into account. To some extent this is true today. Clearly within 10 years it will be so.[2] My colleague disagreed, pointing out that many of her students and former students were the only people in their work settings with computer skills but many in social work settings did not have the need for computers. 

My colleague and I are both correct. The sad reality is that many mental health professionals including members of my professional discipline are woefully inadequate in terns of their computer knowledge and skills. Unfortunately, what we don’t know can hurt us and our clients. It helps if we recognize our ignorance and take steps to correct it. A “little” knowledge can be dangerous. 

Not long ago a prominent, award winning and respected member of my profession whom is also a listserv moderator was reported to have said on a social work listerv that online discussion groups were a great way to discuss cases in detail and delve into dynamics etc. without worrying that patient confidentiality may be violated.

His statement is an example of a little bit of knowledge being dangerous. The Internet for many reasons is about the least safe place for detailed discussions of patients. The number of viruses, worms, and hackers is increasing at a rapid rate. Professional listervs are not immune from these threats. I just received a notice from my college tech center about a new wave of computer viruses and worms. It is particularly onerous when mental health professionals are hacked since they and their patients are violated but also as a rule they are less knowledgeable about computer technology than most others online. That is just my opinion based on studying therapist participation on discussion groups and listservs for some time now.

Marketing programmers have begun to find more sophisticated ways to deceive email recipients. There are a number of “tricks” associated with the latest email-borne viruses and other tactics to disrupt communication online.

“Spoofing” is email identity theft. To entice you to open an email attachment with a hidden worm, the email places parts of the recipient’s email address in the body of the message. The Bagel virus uses this strategy to generate messages purporting to be from the domain or server of someone you know. Another clever trick is to borrow the first name of a spoofed sender and reuse it as a signature in the message body.

And it is a well established fact that tomorrow’s viruses and worms will be even more devious than today’s.

There are less high tech variations of “spoofing” although it may have its own official technical name for all I know, however, they can be just as malicious and harmful as the hi-tech variety. It simply involves putting someone else name in the “From” section on an email device such as Outlook Express, Outlook or Yahoo. This is not the same as creating a “moniker” which is quite common and benign when joining on listservs sponsored by yahoo or MSN. See The Moniker:What's In A Name? But rather the spoofer actually impersonates the name of a real individual. Once another’s identity is impersonated, the spoofer who is now a cyber stalker can say all kinds of dumb and stupid things including the use of insults, libelous statements and profanity and the hapless victim who identity was hijacked will get the blame for being a fool. If the spoofer/cyber-stalker has the skill they can do a number of things to disguise their original ISP address and actually make it appear that the garbage is coming from someone else.

The person whose name of email address has been stolen is unaware of the misuse of their name. Usually, the victim is only alerted when the recipient emails them to ask if they in fact sent the email in question or a message is returned to their email address because it was rejected by the recipients firewall. It is quite disconcerting to receive non-delivery notices of emails to individuals you never heard of and have never contacted!

We have seen examples of this on some listservs frequented by therapists. We have actual documentation verified by experts. No list is no more immune that any other. Any listserv moderator who makes the claim that their list is “safe” whatever safe means from this behavior is either naive or well let’s leave it at that, Naive with a capitol “N”. To their credit, many moderators are anything but naïve and always advises reasonable caution about what one says and interpreting what others say. I have not observed that degree of caution on some other lists that I either participate in or have other associates monitor for our research.

Why would mental health professional deliberately deceive his or her colleagues? First, people may not be who they say and we should not assume that everyone on a discussion group or listserv is a professional. They may or they may not. That is part of the problem. But whoever they are, understanding anyone’s motivation is difficult even for the clinically trained. The best we can do is examine the results or consequences.

The foreseeable consequences of failure to understand the internet is danger. It is danger not only for anyone who is online but if they are therapists who fail to understand the intricacies it is dangerous for their patients. What your therapist doesn’t know can hurt you as well as themselves. 

And that brings me full circle to the Chinese language again. In Chinese the word for crisis, , "weiji" (or ). It contains the character "wei" which means danger, and the character "ji", which means opportunity, or crucial point. A crisis presents a moment of opportunity as well as great danger. A language reflects the understanding that culture has of itself, and influences how people in that culture think.....

The analogy is that while the use of the internet has its dangers there are tremendous opportunities. The challenge here is not to over or understate the dangers but understand them well and deal with them effectively 

[1] See http://www.energycrisis.com/ch/crisis/

[2] A recent Wall Street Journal indicated that the US Federal Government has plans for the computerization of all medical records with in 10 years. See Wall Street Journal, April 27, 2004
http://online.wsj.com/article_print/0,,SB108303337718394427,00.html

 

 

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