    
Securing Sexuality is the podcast and conference promoting sex positive, science based, and secure interpersonal relationships. We give people tips for safer sex in a digital age. We help sextech innovators and toy designers produce safer products. And we educate mental health and medical professionals on these topics so they can better advise their clients. Securing Sexuality provides sex therapists with continuing education (CEs) for AASECT, SSTAR, and SASH around cyber sexuality and social media, and more. Links from this week’s episode: 
Ethical Considerations for Mental Health Professionals - Understanding Mandatory Reporting Laws and Disclosure/Informed Consent
As technology continues to evolve, so too do the ethical guidelines and mandatory reporting laws for therapists. In the digital age, it is essential that therapists understand how to navigate these new rules and regulations in order to provide their clients with the best possible care. This article will explore the ethical guidelines and mandatory reporting laws that therapists must adhere to when providing services in a digital setting. The first step for any therapist is to become familiar with the ethical guidelines set forth by their professional organization or licensing board. These guidelines will provide an overview of what is expected of a therapist when providing services online or through other digital means.
It is important for therapists to understand these guidelines as they are designed to protect both clients and practitioners from potential harm or exploitation. Additionally, understanding these guidelines can help ensure that all therapeutic interactions remain within legal boundaries. In addition to understanding their professional organization’s ethical guidelines, it is also important for therapists to be aware of any applicable state or federal laws regarding mandatory reporting requirements. Depending on where a therapist practices, there may be certain situations in which they are required by law to report certain information about their clients’ mental health status or behavior. For example, some states require mental health professionals to report any instances of child abuse or neglect that they become aware of during therapy sessions with minors. It is important for therapists practicing in such states (or those who work with minors) to understand what types of information must be reported and when it must be reported in order for them to remain compliant with state law. Finally, it is essential that all practitioners working in a digital setting take steps towards protecting client privacy and confidentiality at all times. This includes ensuring that all communication between client and practitioner takes place over secure channels (such as encrypted emails), as well as taking steps towards securely storing any records related to therapy sessions (such as notes taken during sessions). Additionally, if a practitioner chooses to use video conferencing software such as Zoom or Skype during therapy sessions, they should take extra precautions such as using passwords on meetings and disabling screen sharing features whenever possible in order to protect client privacy even further. In conclusion, understanding ethical guidelines and mandatory reporting laws for therapists has become increasingly important in the digital age due both increased access technology provides individuals seeking mental health services as well as new regulations governing how practitioners can interact with clients online safely and ethically. By familiarizing themselves with their professional organization’s ethical codes, being aware of applicable state/federal laws regarding mandatory reporting requirements, and taking steps towards protecting client privacy/confidentiality, therapists can ensure that they remain compliant while providing quality care online. Key Concepts:
Hello and welcome to Securing Sexuality, the podcast where we discuss the intersection of intimacy and information security.
I'm Wolf Goerlich. He's a hacker. And I'm Stefani Goerlich. She's a sex therapist. And together we're going to discuss what safe sex looks like in a digital age. Today we are joined by my friend, clinical sex therapist, Bible scholar, president of The School of Sex Therapy, Caleb Jacobson. Caleb, it is so nice to have you join us. Well thank you all so much for having me. It's such a pleasure to be here with you all. Yeah, it's great to have you on for a number of reasons. One being, as a guy named Wolfgang, I have a certain affinity for Germany. Tell us about your work and what motivated you to move your practice and your life and your livelihood from the US to Germany. So I got to tell you, I never thought in a thousand years that I would ever end up in Germany. It was never part of the plan whatsoever. So in 2017, which seems like a century ago after going through the pandemic and all of this, I was in Germany. I was in Israel doing an archaeological dig and then got invited to Germany on a research grant for about a month. And I really didn't want to go. I did not want to come to Germany, I wasn't excited about it. My grandfather was in the States. He was, his health was doing very bad, but I had this research grant, I had already gotten the money. So I kind of had to be there. And so I got to Germany and I got off the train. I remember thinking this is going to be the longest two weeks of my life. Like it just isn't, I'm not going to enjoy this. And then the cab took me from the Hauptbahnhof, which is the main train station, to the place that I was staying. And it was in July and you know, July is rather warm and I walked in and then I realized there was not - they don't really use air conditioning either. And you know, I really thought at that point, this isn't going to work. I'm just going to leave now. However, while I was here for this period of two weeks, I had gotten an invitation from the head of the biblical archeology department to come and write my second doctorate in Hebrew Bible and biblical archeology. So that was the end of July, beginning of August. I go back to the States. My grandfather passed away, unfortunately. And then by March of 2018, I was on a plane to Germany and have been here ever since. How the practice came about was I was under the impression that I would get some funding. I'm going to give, listen, I have never said this publicly out loud, but you're going to get this special on your show just because I love you so much, Stefani. So I thought I was going to get funding. I was told I was going to get some funding, but because I wasn't a member of the church, I was unable to get funding and they had to have a special vote to allow me in the department. And then they had - I just couldn't get any funding. So I already had my doctorate in clinical psychology, and went into private practice. So I have to ask, did you even speak German when you got there in those first two weeks? So for the summer school, my German was terrible. But the thing is in biblical studies, you have to have a secondary research language at the PhD level. And usually people use French or German. German's most common because most of German theology and even if whether we're talking in a Christian context with like Luther and Karl Barth and Schleiermacher, or if we're talking in terms of Judaism with Mendelssohn and Abraham Geiger and Samson Raphael Hirsch, all of them were German and wrote and dealt in German. So the language is very important. There's a lot of academic literature written in that. So it's very important to learn. I ask because when I was in high school, I was fascinated with, you know, the World War II era and the culture and people at that time. And I desperately wanted to learn German so that I could read source documents in the original language. Right. And so it turns out I'm absolutely terrible at languages. My high school German served me not at all. And the first time I was in Vienna, I tried to purchase some coffee and I could not remember the German for kilogram. And eventually the sales girl yelled at me and was like, look, we all speak English here. Please stop butchering my language. So German proficiency is a talent I'm incredibly jealous of and have long wanted and sorely lack. I just I had to ask. The Germans have a terrible proficiency at it either, especially when it comes to like, you know, de der das. Like they really are, this is problematic. It's hard, German's hard. German is hard. And the work that we do is not to create the world's most forced segue, but the work that we do, it can also be hard. Right. Like we some of us in our field work with mainstream everyday couples that are dealing with differences in desire or libido changes or aging. But you and I are both kind of different in that we work with some more challenging cases and a little bit more niche populations. And I would love it if you could tell us a little bit about who you work with in your practice. When I started my practice, it really focused on working with religious clients. There's a disparate age between religion and sex. Sometimes it seems to be like a great divide between people being able to be comfortable with their spirituality and with their sexuality. And that's something that I was very interested in working with and work with a wide range of religious backgrounds through a wide confessional sweep. So I often make the joke that I find it funny that I, you know, am a Jew living in Germany, working with a lot of Muslim clients in Saudi Arabia. Like that's kind of like, you know, that's not the life that you would imagine. You know, I work with a lot of Christian clients as well, from Catholics to Lutheran to fundamentalist. I work with a lot of evangelical groups, the United Pentecostal Church, for example, Southern Baptist Convention. And in Judaism, interestingly, I work a lot with Chabad, who sends a lot of people to me, and work with these couples through a wide range of sexual issues ranging from unconsummated marriages, sexual dysfunctions, and so forth. And because of the work that I was doing and because of my background and being both psychology and in biblical studies, while I was in Germany, there happened to be some big news, as it was in the US as well, about sexual abuse within the Catholic Church. And so, I was asked if I would be willing to work with clergy who were involved in this. And I said yes, because, you know, the same thing is, like, they don't really trust modern psychology. They would trust someone who is more understanding of biblical text. And I found that it was challenging to me as well, because I was working with a population no one else was working with. Here in Germany, unlike in the US, we do not have mandatory reporting laws. And as such, it's actually considered a breach of client privacy, and Germany's very big on privacy laws. So like, you cannot even get your photo taken in a public area without signing a consent form saying that your photo can be taken in this public area. So if you are somewhere and they're having a party and they take photos, you have to sign a release form. So they're very strict on privacy in that way. And so if a client was to tell me something that I think is problematic, I could not go and report it or I would go to jail as well. They would too, but I would also be right along with them, with the exception being if they threatened to hurt me or my family, which typically doesn't happen. But this has given me the license, if you will, to work with a wide range of clients who engage in a wide range of sexual behavior, who obviously that behavior is problematic to them enough where they are coming to therapy and to get help with what's happening. So that's fascinating to me because, you know, as somebody who practices in the United States, who is trained in the United States, who follows ethics for NASW, mandatory reporting is a part of the air that we breathe. And I think it's a really big part of American culture too. I know that when my son was little, people were always very fearful of, you know, what if the teacher says something or what if somebody makes a false allegation about us. And as my child has aged and our friends have had kids, that's still a topic of conversation. There's a lot of fear in the United States about mandatory reporting being used inappropriately or as an error. And I'm fascinated that that's not a universal norm. Yeah, you know, it's interesting because if I was to go outside and I was to grab a German, like even if I took a college student and I discussed with my clients or with one of these students, this idea of mandatory reporting, and this has happened. So I'm not, this is not just, I'm using as a theoretical, but it's happened. They've often said to me, well, why would that person ever come to therapy to get help? And I said, well, they wouldn't, right? Like obviously if a person knows that you would have to report them, they're not going to come to help. They're not going to come for help. And so in the German mind, it's very practical that obviously you wouldn't report this person or else they would not come to you for assistance. And that makes a lot of sense when you say it and it's just not at all how Americans think. No. And I got a lot of pushback. I'll tell you, when I first started doing, working with certain populations, I got a lot of pushback from people and you know, they talked on the lines of like abuse and different things. And I thought in the U.S. we're very retroactive. We help people after there's been a problem. Instead of being proactive and providing treatment and help so that there isn't a problem. And so I think a lot of my work is very proactive and helping people deal with issues, desires, compulsions that they have that could be problematic and helping them to find some form of congruency in their life where they are not controlled by their thoughts or impulses or desires, and have control over those elements. And as such, they're not defined by that. It's just a small piece of who they are. And this is very important because I think it helps not only the client, it helps potential victims, but it also is good for society and overall. Yeah, I really like that line you just drew between being proactive and reactive. I think you're spot on and oftentimes as well in the U.S. we tend to be very punitive. Like we will fix this problem by throwing these people in jail for the longest possible time. I had a question though, jump back just a minute, because when you were talking about Germany and cameras, it reminded me that there was recently a car manufacturer that got penalized because their cars were all shipped with video cameras. The video cameras were up front. They're designed to protect the cars from theft and damage. And of course that made its way over to Germany and people were like, no thank you. I wanted to know, is there differences in privacy culture that you see above and beyond that, right? What are some of the most ways that people think in Germany about privacy translate into not only therapy, but also the technology? So technology is a big one, right? For example, because of the privacy laws, certain things don't show up on Google. Personal data isn't available. I will tell you, I don't get spam phone calls like you do in the US. That's one thing I really enjoy is that my personal data and telephone number, I'm not getting 10 calls a day from a telemarketer or someone trying to tell me that my warranty is out of a car that I don't even own anymore. So it's kind of beneficial, right? In some ways it's very beneficial. When it comes to the personal life of people, especially in a therapeutic context, it sometimes takes a little bit longer for a person to really open up and divulge information. And sometimes they're a little bit more careful to divulge information that's also related to another person. Now that doesn't mean they don't do it or not that they're not willing to do it, but they need to make sure that they are in a safe and secure space, which is what all clients need, right? It doesn't matter if we're in the States or if we're in Germany or if I'm in Israel, it doesn't matter. People need to feel a sense of safety, especially when we're talking about issues related to sexuality, which is something that people don't feel secure and safe with anyways. I think that sense of safety and that ability to create a trust bond between the clinician and the client, no matter what they're talking about, is so important. And that's something that comes up in the conversations that Wolf and I have here frequently. We have people pitch us an idea for a new app to help married couples figure out what fantasies they have or to help kinky singles find people to date. And the first question that we always ask is, how safe is this? What are the odds that this information is going to get out if somebody uses your product? And it's a question that I think a lot of Americans ask about the quote unquote product of therapy, right? They want to know what is safe here? What can I say? What are you going to hold in confidence and what is going to expose me to risk? And especially for people that experience stigma or who come from marginalized populations, that ability to feel safe in therapy is often not easy to come by. And it absolutely can get in the way of doing the healing work that they're trying to do with us. Absolutely. You know, it doesn't matter if I'm working with a religious client where there is this disparity between, you know, they don't necessarily feel safe in a therapeutic setting, thinking that it could be mutually exclusive to their religious beliefs or find things that challenge their religious traditions. Or if I'm working with a sex worker, right? I do a lot of work with sex workers or people who have problematic sexual behaviors. It doesn't matter, right? Like, they come for this sense of, with the sense of uncertainty of knowing that they need and want help. Like, I always tell clinicians who don't like to work with any of these populations, the fact that they've come through the door shows a lot. That's really taking initiative. That's really making a bold move when it could cost them a lot. And sometimes we don't recognize that. We don't, for example, with a religious client, if it goes against the teaching of their particular religious community and their particular religious leader, where you're going to therapy instead of seeing that religious leader, it could mean excommunication. It could mean public discipline. It could mean, you know, being shunned by the community. You're losing your entire support system, your entire network, and you're basically being left out in the cold. There's a lot to lose there. For clients who have problematic sexual behavior or participating in illegal sexual behavior, disclosing something to a therapist could mean the difference between their freedom and being in jail. That safety and that sense of safety is so important to build in the therapeutic process. In addition to what we just talked about, reducing the concerns about mandatory reporting, my natural inclination goes to if I wanted to put something on someone, I would try and gather information. Not that I would do that, but my natural inclination goes towards how folks may misuse information. Are there any practices that you have developed around your notes or around the type of information that's gathered in the session? I'm assuming things aren't recorded, as we've already talked about with respect to privacy and video. How do you handle other sense of information around those clear and patient engagements? Yeah, so this is tricky. I benefit from the fact that, one, I hate taking notes. So when I take notes, they're kind of all clustered all over the place. So you probably couldn't read them. If you read them, you would think I had lost my mind or something. So that helps. What I think is more interesting is clients that I have who engage in illegal material, I change a lot of my protocol for therapy. So for example, I don't require them to fill out an intake paperwork. When we do sessions via Zoom, I don't require them to have their camera or use their real name. I mean, even for certain populations, I have group therapy available for. And because I don't want them to communicate with each other outside of group for safety reasons and for I don't want them to get tempted in certain ways. So there's protocol around this. Again, they don't have to use their name. They don't have to have their camera on. The chat function is disabled, so they cannot send messages back and forth and exchange information. A link to the room, they have to register a few days before the session begins. And then a link is sent out only 10 to 15 minutes before the session begins to make sure we monitor who's coming in, that these people have been vetted, and that it's safe for everyone in the group. And so there is protocol in place and there are considerations that do have to be made. I have a hard question, I think, that I suspect a lot of our American listeners have in their minds right now, which is, especially as a person of faith who works with these more challenging cases, how do you personally navigate maintaining those protections for them and affording them a certain level of anonymity and confidentiality without feeling like in some ways you're complicit in whatever behavior is bringing them to you without carrying what an American clinician would feel as a sort of ethical burden from that? I would say a few things. I would say that as an American clinician, I often worry that their focus and goals in therapy are sometimes not in the client's best interest. And what I mean by that is often there is a focus on social justice in the US that we don't have in Europe as much, and this focus on social justice can, and I've seen it happen with therapists, impose on a client's autonomy or the idea that I have to educate this client or I have to change this client's belief system. I'll give an example. When working with religious clients from certain backgrounds, I have heard many therapists say, the problem is this person's faith or they need to leave their religion. I've had clients come to me who said my last therapist said I needed to leave my faith, right? This is problematic. This is really problematic. Now, do I think the therapist thought that this was in the best interest of the client? Yes, I'm not saying there's any ill intent, but our own biases get in the way is what I mean, right? When we focus on social justice, which I'm not saying we shouldn't, that's very important for us to do, but it's easy to get caught up in that and to allow our biases to get in the way of doing what is best for the client. I'll also say that people practicing therapy, particularly sex therapists, run from a wide range of ethical codes and licensures, right? So you have psychologists, psychiatrists, licensed counselors, you have marriage and family therapists, you have social workers, right? Who all come from very different perspectives with very different organizations that have very different code of ethics. This makes the situation in the conversation even more confusing. To me though, as an Orthodox Jew, what I would say is that I am really inspired by Tikkun Olam, repairing the world, right? And when I see people who are broken, and listen, I've had clients who have said to me who are involved in illegal behavior, do I feel comfortable working with them? And I usually say the same thing. You mean someone who has so much anxiety and who's hurting and who is ashamed and who wants a change in their life? That describes all of my clients, right? They've come to me for help, they've trusted me to come for help. So I don't work with people who are in the court system. This is a different area. I'm working with people who may be involved in illegal behavior, but who do not want to be involved in that behavior. And they're coming to me so that they can get control over that behavior and stop. So that's where the ethic is, is I'm not saying let's just send them to jail. They come out of jail, do the same behavior again. Let me provide them with the tools and resources where they can stop doing that and then become a productive member of society. And that's paramount. I love that framing. That is such strong framing that my goal is to help people be better. My goal is to help repair the world. And you're right. There seems to be a lot of fragmentation around group to group as to where the ethics are. And I'm just saying this as an outsider, as a technologist, it's not much better with our certification bodies. However, do you find that there is any movement globally towards an agreement or at least a consistent framework for helping doctors or therapists through these decisions and discussions about when to uphold confidentiality and when to violate confidentiality? This changes from country to country. In the US, it's even more confusing because state-to-state it changes. It's really confusing to navigate. As such, I don't think it's possible to have one uniform code or to ever reach a consensus on this. I think it's absolutely impossible to do for so many variables. And it's kind of unfortunate. However, with that said, I will say that I really appreciate the opportunity in the context of which I practice to be able to work with whoever is coming to me for help. I think that's so important. And I think that your openness and your philosophy and the legal and ethical system of the countries you practice in is an important framework to embrace. I think about the research on my own people, the BDSM and kink population. And I've read studies saying 30% of them have experienced stigma from their mental health providers. And I've read studies with clinicians saying similarly to you about certain religious traditions that they've given their kinky clients ultimatums and said, if you want to keep working with me, you need to give up your kinks or you need to change your power dynamic. And really looking at these coercive tactics as therapeutic growth. And I really love the way that you have expressed why an alternative perspective is so important. You made me think of the, there's an Aboriginal activist named Lila Watson. And one of my favorite quotes of all time is from her and she says, you know, if you've come to help me, you're wasting your time. But if you've come because your liberation is tied up with mine, then let us work together. And I think that that idea of therapists aren't here to help or to save or to rescue or to preach. We are here because our liberation is bound up with our clients and we can do that work together on a level playing field like you establish for both your religious clients and your perhaps potentially in some cases criminal clients and meeting them in the same place and saying you're here because you want to change. And that makes you just like every other one of my clients. So that puts us all in the same place is really quite beautiful. I cannot tell you the number of clients who have wept open, like really wept. And I've cried. I will tell you, I usually get big jokes about my form of therapy being not necessarily affirming. I don't really do affirming therapy. And I don't, we were at the European Society of Intersexual Medicine and they were talking about microaggressions. And I said, well, you know, my form of therapy is macroaggression therapy. Like I'm very like forward and direct with my clients. But at the same time, I've often sat there and wept and cried with clients, right? Where they have been able to actually say and discuss things that they've never been able to say and discuss before and really confess some of their fears, right? Like the things that they're fearful of or that they're worried about or, you know, usually it comes down to the fact that they're crying because they never thought they would be able to get help. Okay. The fact that someone is, realizes that they have a need and they, or they have something they're doing that they need to get control over. They need to stop or, you know, there's thoughts that they want to stop that it's bothering them and they're feeling stress and anxiety and depression over wanting to end their lives many times. And for them to be able to come and sit in a space and to tell me, I never thought I would ever be able to get help for this. It's very rewarding work. Very rewarding. So as we come to our end of our time together, I have a question for you. I'd just like to know building on top of that, what do people need to know to access help and to access help safely, right? How can they reach out to people like you? And also related to that, of course, related to the topic of this podcast, how can technology make them safer or feel safer? So what's really helpful is when you're meeting with a client or meeting with a therapist, speaking from the perspective of a client, meeting with a therapist, it's important to ask them the question of what are your mandatory reporting laws? Now as a therapist, we talk about disclosure and informed consent and talking to clients about this. But to be fair, many therapists do not fully understand the ramifications and boundaries of their own ethical guidelines and mandatory reporting laws. They do not, they just don't know. It's a complicated thing, right? A lot of people don't live in the same state. They don't practice in the same state that they did their studies in, you know, life changes. It's very complicated and laws are always changing. So for a therapist, they need to stay well informed of this. As a client, it's important to ask the therapist specifically what are the boundaries for this. If the therapist doesn't know, they need to find out. Because honestly, a lot of therapists kind of jump the gun sometimes. This happens a lot where they just get like a little trigger happy and something is brought up in therapy that maybe doesn't even require mandatory reporting, but they do because they don't know the line. It causes a lot of problems for the client. So clients are hesitant to go and receive treatment. So clients need to ask the therapist. The other thing you need to do, thanks to the digital age, thanks. The one thing that was positive that came out of COVID was more people are more accepting of treatment virtually, which is fantastic. And you can find clinicians that are able to help you regardless of location. And it's very important that you reach out to people who can give you the help that you need. There are several organizations that are available for different problematic sexual behaviors, and they can often help you locate a clinician as well. I love that. And I would just add clinicians, talk to each other, find your friends like Caleb and I, and ask them about those things that might feel uncomfortable for you and you're not sure where your ethical duty lies. Talk to each other before you pick up the phone. You can always make an ethical report if necessary, but take the time to be more like Caleb. Take the time to center your clients, to think reflectively, to act ethically, and to do what's best for you, the people you serve, and the community that you live and work in. Just like Caleb, because Caleb, you are absolutely my role model of the day, and I thank you so much for being here with us. This has been an amazing conversation. Well, I'm so glad y'all have me. I hope you'll have me come back sometime. Oh, we absolutely will. There's so much we could talk about. For sure. Thank you, Caleb, and thank you so much, our listeners, for tuning into Securing Sexuality, your source of information you need to protect yourself and your relationships. Securing Sexuality is brought to you by the Bound Together Foundation, a 501c3 nonprofit. From the bedroom to the cloud, we're here to help you navigate safe sex in a digital age. Be sure to check out our website, securingsexuality.com, for links to more information about the topics we've discussed here today, as well as our live conference in Detroit. And join us again for more fascinating conversations about the intersection of sexuality and technology. Have a great week. 
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