This hypothetical scenario raises serious ethical concerns regarding client confidentiality and privacy. Art therapists have a duty to protect sensitive client information and avoid any disclosures that could identify clients or compromise their treatment. While discussions of clinical experiences can aid professional development when handled carefully and anonymously, online sharing requires utmost discretion and oversight to prevent any violations of trust or consent.

1. +
Issues & Ethics of Art Therapy in a Digital Age
September 7, 2012, Dublin, OH, Buckeye Art Therapy Association
Presented by:
Cathy Malchiodi, PhD, LPAT, LPCC, ATR-BC
Donald Cutcher, MA, ATR-BC, HLM/BATA

2. +
Summary…
This presentation provides
attendees with an overview of
major aspects of “Art Therapy
2.0,” digital technology and
social media as they apply to
work with art therapy clients.
The emphasis is on emerging
applications in art therapy and
ethical challenges
encountered in using digital
media (digital art therapy) and
Internet-based technology in
work with clients and
information transfer.
iPad…Tablet Technology

3. +
Our Goals & Objectives…
This presentation’s goal is to provide an overview of
digital art therapy and social media, with an
emphasis on the ethics of technology with clients.
Participants will:
1) Learn at a working definition of “digital art therapy;”
2) Learn at least three forms of social media used by
art therapists and clients;
3) Learn at least three possible ethical challenges in
using digital technology and social media.

4. +
What is Digital Art Therapy?
 All forms of technology-based media,
including digital collage, illustrations, films
and photography in therapy
 May involve computer keyboards or screens
 May include tablet technology and smart
phones
 May include any manipulation or generation
of images by electronic means

5. +
Generation Z: The Digital Nation…
 Children and adolescents
now make up the “digital
generation”
 Called “Gen Z” and born
in the mid-1990s
 Grown up with digital
technology ~ do not know
of a world without it.
 Clients are beginning to
demand to use technology
in sessions…how will art
therapists respond?

6. +
Applications of Digital Art Therapy
with Children and Adolescents
 It’s not all the “work of
the devil”… it’s has
many positive
applications.
 Mostly in hospitals
where tablet technology
[iPad] and cameras are
used.
 Specific applications
with some populations
such as autism are
possibly more effective
than traditional media.

7. +
Apps, Apps, Apps…Here are just a
few!
Doodle Buddy and
others…
Comic creators and
graphic novels…
Mandala drawing
and coloring
programs…
Stress reducing
programs such as
Zen Garden…

8. + Adaptive Technology
Using technology
for individuals with
quadriplegia or
traumatic brain
injury
Helping those
children who are
hospitalized
communicate with
others [Starbright
Foundation for
example’]
Starbright World®

9. +
Virtual Reality Therapy (VTR)
 Mostly used with
posttraumatic stress in
adults as “exposure
therapy”
 Also being used with
children and
adolescents who have
physical disabilities so
they can practice skills
in virtual reality and
develop a sense of self-
efficacy
Electronic Visualization Lab

10. +
Small Group Activity…Discuss the
following questions.
 What are the challenges to confidentiality when
using an iPad or digital camera as media with art
therapy clients? Is there a potential for a HIPAA
violation?
 How would you handle security and storage of digital
images produced by art therapy clients? What
standards does your agency/institution have in
place?
 If you use digital media in art therapy, what would
you include or change about your informed consent
given to clients or guardians/parents?

11. +
Digital Art Therapy
It’s our ethical responsibility to know what works
and what doesn’t and to look at client welfare.
Sometimes “digital art therapy” may be the best
approach, but it comes with ethical challenges.

12. +
What is Electronic Media?
 Broadcast or storage media that takes advantage
of electronic technology
 May include television, radio, Internet, fax, CD-
ROMS, DVD, and any other medium that requires
electricity or digital encoding of information.
 Also includes other forms of news publication,
including websites, blogs and social networking
sites.
 The term “electronic media” is often used in
contrast with print media.

13. +
Current “Superfecta” of Social
Media
 Facebook
 Twitter
 LinkedIn
 Pinterest

14. Example of Pinterest Page

15. +Electronic
Media…digital
art images,
records, social
media, films and
more…
What are the
ethical concerns?
Confidentiality
challenges?Legal
issues?

16. +
Health
Information
and Digital
Transmission
Protected Health
Information: HIPAA
Privacy and
Security Rules

17. +
About Electronic Media…
“Even before you put electronic client
information or an image online or send it
by e-mail it is at risk.”
“The risks for electronic data can be
internal, external, and random, and can
result in data damage, falsification, loss,
or leakage.”
P. Orr (2011), ATCB Summer Review

18. +
ATCB Ethics Code
 3.11.5.1 Addresses issues related to the difficulty
of maintaining the confidentiality of electronic
transmitted communications, and the difficulty in
removing any information or imagery that has
been posted electronically if consent is later
revoked.
 3.11.5.2 Inform clients of all colleagues,
supervisors, and employees (including
Informational Technology (IT) administrators, who
might have access to electronic transmissions.
ATCB Code of Professional Practice states:

19. +
More from ATCB ethics document...
3.3.1 Art therapists shall
not engage in any
relationship, including
through social media,
with current or former
clients, students, interns,
trainees, supervisees,
employees, or
colleagues that is
exploitative by its nature
or effect.

20. +
Small Group Activity…Discuss the
following questions.
Should you have a Facebook Page for your private
practice? What are the risks? Are there situations
when it is acceptable?
Should you post client artwork or films of clients in art
therapy/counseling sessions to your Facebook Page? Or
elsewhere on the Internet? What are some of the ethical
issues involved?

21. + Facebook Page & Professional Practice:
Commentary from Keely Kolmes, PhD, 2009
“If you are using your Facebook profile to establish your
professional identity or to attract, connect, or interact
with potential or current clients and colleagues, your
Facebook presence has now become part of your
professional space. This means that legal and ethical
provisions may now apply to your online activities.”
“Accepting client requests to “friend” you can be
perceived as an extension of your professional
practice. Be aware that professional relationships
come with legal and ethical responsibilities which do
not cease to exist just because you are on a social
networking site.”

22. True or False? What is the strangest
thing you have read that has been
posted by a peer professional?

23. +
Some of our experiences…
Cathy: “A professional art therapy colleague posted that
she was getting a divorce from her husband because
one of his relatives was abusing their child.”
Also seen via colleague’s Facebook
postings…expletives, culturally insensitive jokes,”I read
50 Shades of Grey,” and public questions about “how
to I deal with a client who…”
Don: “A professional colleague posted video tapes of
sessions with a minor child onto the person’s facebook
professional website. It included identifier of client, as
well as no masking of face or image. This was reported to
the ATCB and AATA, as ethical violations of codes and
resolution was requirement for person to remove all data
and respect confidentiality.”

24. +
A “hypothetical” case
scenario.
Posting Client
Films to
Facebook…it
happens.

25. +
Have you Googled yourself lately?
 On July 23, 2012,”Donald
Cutcher Art Therapis”t has
19,200 hits on Google…
 On July 23, 2012, Cathy
Malchiodi has 540,000 hits (she
has a lot to look into…)
 Major sources of Google hits:
Social media such as Facebook
activity and websites with your
name on them.
 Your clients can see them all.
 Nothing ever disappears from
the Internet. Nothing. Really.

26. +
And what if a client read this on the
Internet…
“…There was also the good-looking 30-something manic guy, who drove
hundreds of miles, went out on the town, drank all night, met a lady, went
home with her and decided to “show her the proper way to commit
suicide.” The girl found him in her bathroom with double wrist and neck
lacerations. He survived to tell the story (to me) and continued to try to
take his stitches out (while in the unit) by use of the electrical outlets on
the wall. He really liked art, though.
I write a lot of progress notes for my patients that include statements like
“she remains resistant to therapeutic intervention and spends most of her
day in bed, talking to Jesus” or listen to proclamations like “you know, I
was born in 1786 for the 4th time?” “No, I didn’t know that. What is that
like?”
From “Art Therapist Works with Dangerously Psychotic Patients” on
BuzzFeed website, written by anonymous Licensed Creative Arts
Therapist.