Biomedical subjects
Patricia R Recupero
Publications and source records attributed to Patricia R Recupero.
Law & psychiatry: Legal concerns for psychiatrists who maintain Web sites.
Courts recognize three types of Web sites: passive, which provide basic information; business, on which business is conducted; and intermediate, which are somewhat interactive but conduct no business. Inviting contact from site visitors may lead to inadvertent doctor-patient relationships, with ensuing legal duties. Statements made may be considered explicit warranties, which are subject to lawsuits when not fulfilled. Providing services to out-of-state clients may amount to practicing without a license. The author reviews Federation of State Medical Boards guidelines for appropriate use of the Internet in medical practice and offers ethical principles to help guide decisions about structure and content of passive sites.
Characteristics of e-therapy web sites.
OBJECTIVE: This study examined what a person seeking e-therapy services might find on the Internet, and how e-therapy Web sites characterize their services and providers. METHOD: Using the search engines Google and Yahoo!, we obtained a list of 55 e-therapy Web sites, which we reviewed from May 2005 to September 2005. We used the search terms online counseling, online therapy, and e-therapy. We reviewed the Web sites' content for data in 7 categories: description of services, terminology for providers, providers' qualifications, terminology for service users, characteristics of clients, information for individuals in crisis, and information about confidentiality and security. RESULTS: There was a wide range in the Web sites we accessed. Web sites often contained confusing information about the nature of the service offered and did not always specify qualifications of providers. Some providers did not appear qualified to provide the services the Web sites advertised. Other sites offered Internet-based services of legitimate mental health professionals. Most sites referred to users as clients rather than patients, and some sites specified criteria that would render prospective clients ineligible to receive services (e.g., suicidality). Some Web sites excluded individuals with specific diagnoses. Web sites were not generally proactive about providing resources for visitors in crisis. Less than half of the Web sites disclosed limits to client data security and confidentiality. CONCLUSION: Experiences with e-therapy might influence a patient's attitude toward traditional psychotherapy. With the wide variety in e-therapy services that are searchable on the Web, clinicians may want to be more aware of what their patients might encounter online.
From asylum to neurobiology and behavioral genetics: Butler Hospital today.
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Informed consent to e-therapy.
E-therapy, the provision of mental health treatment through the Internet, poses many risks as well as benefits. This article addresses some relevant risks and benefits of e-therapy and discusses the practicality of using computers in the informed consent process. Although e-therapy has numerous proponents, no clinical trials have assessed its long-term effectiveness. To limit liability and to protect patients, e-therapy providers should disclose material risks as well as possible benefits and engage patients in an active dialogue. A thorough informed consent procedure enables patients to make an educated decision about whether e-therapy is right for them. In the future, e-therapy and informed consent online may become more common; in the mean time, clinicians must be prepared for e-therapy's uncertain legal status and allow patients to decide for themselves whether or not to seek counseling on the Internet.
E-mail and the psychiatrist-patient relationship.
E-mail correspondence between psychiatrists and patients raises numerous legal concerns with respect to the ethics of the doctor-patient relationship. Case law has shown that a doctor-patient relationship may be established in the absence of face-to-face contact. Despite this, a surprisingly high number of physicians respond to unsolicited e-mails, some even going so far as to suggest diagnoses or to offer advice. Courts may decide that a doctor-patient relationship exists where a psychiatrist has corresponded with a patient by e-mail. Psychiatrists may be faced with difficult ethics-related decisions regarding unsolicited e-mails from members of the public as well as e-mail from current patients and third parties, such as family members of patients. This article addresses relevant law and ethics guidelines and seeks to assist psychiatrists in making sound, ethical decisions about the professional use of e-mail.
Boundaries in psychotherapy supervision.
OBJECTIVE: This study examines the perceptions of trainees and supervisors on the boundaries of the supervisory relationship. METHOD: A 19-item questionnaire about the appropriateness of the actions of a psychotherapy supervisor was completed by 43 supervisors and 52 trainees. It was distributed at Grand Rounds and mailed out to psychotherapy supervisors in the community. RESULTS: Generally, trainees and supervisors agreed about the boundaries of supervision. Only one item indicated a significant difference between trainees and supervisors. Trainees considered the discussion of sexual fantasies as less appropriate than did supervisors. Using factor analysis, two scales accounted for 66% of the common variance. Supervisors scored higher than trainees on scale 1 (F = 5.14, df = 1.92, p = .03) and women scored lower than men on scale 2 (F = 9.88, df = 1.92, p = .002). CONCLUSION: Scale 1, a set of items related to sexual topics, revealed a significant difference in supervisor/trainee response with supervisors considering discussion of sexual items as appropriate compared to trainees. Scale 2, a set of items related to self-disclosure, revealed a significant difference with male respondents favoring looser boundaries and more self-disclosure than female respondents. The boundaries of the supervisory relationship are important concerns for our profession. This is the first study to provide an empirical evaluation of perceptions of trainees and supervisors on aspects of boundaries in the supervisory relationship. If the findings are replicated, they could contribute to future analysis of trainee/supervisor relationships. The maintenance of good boundaries between trainees and supervisors is crucial to the integrity of the supervisory relationship.
Gender differences in the practice patterns of forensic psychiatry experts.
In the past 25 years, the number of female forensic psychiatrists has increased dramatically. To assess whether there are gender differences in the practice patterns of forensic psychiatry experts, members of the American Academy of Psychiatry and the Law were surveyed during an annual business meeting. Women in the sample were shown to perform fewer categories of evaluation than men. Women were less likely than men to do criminal work, civil commitment/involuntary medication evaluations, and testamentary capacity evaluations, but there was no significant difference in the percentage of those performing some personal injury/disability/fitness for duty, custody, sexual harassment, or malpractice evaluations. Gender was not a significant factor in determining hourly rate. When subjects were asked to comment on whether they thought that gender was a factor in the selection of a forensic expert, 80 percent of the women, but only 41 percent of the men, believed that gender was a consideration.