Looking back, it seems ironic that I haven’t written much since then about mental health or mental illness in tech culture especially when I consider that a large proportion of the people who seek my help have careers in tech. It’s as if I’ve forgotten that it’s worth mentioning.

And it’s really not.

Prodded by the recent suicide of Ilya Zhitomirskiy, one of the co-founders of Diaspora (a site, I had eagerly awaited due to multiple privacy failings on the part of Facebook), Violet Blue wrote a great post about called Tech’s Relationship With Depression, Suicide and Asperger’s. I share many of Violet’s concerns and she interviewed me for this article which includes a number of my comments.

Our friends and family in tech culture may suffer and struggle in ways that we may not see or just may not know how to identify. It’s hard to get someone the help they need when you don’t know they are suffering or if their coping or personality style involves masking their pain.

It’s not that people in tech are so special or different from anyone else, but working in the digital realm does involve the pressures of internet attention, visibility, or “celebrity,” which can sometimes be unexpected and overwhelming. Others may not realize that their normal ways of coping keep them isolated and deprived of support. I hope people will check out Violet Blue’s post which provides links to APA and NIMH’s resources for depression and suicide.

And if you or someone you know needs help, find a professional who you can talk to about your stress. There are low-fee options in every city. College counseling centers and counseling, psychology, or social work training sites may be good places to look for low-fee options. Larger sites such as APA’s Psychologist Locator and Psychology Today provide listings for private practice clinicians.

But whatever you do, talk to someone and let them know that you need some support. There is no need to suffer in silence. People are there to help you, and if you are thinking of taking your life, know that you will leave behind people who will miss you and who will wish they could have reached out to help.

We’ve just completed a Youtube video on the benefits of talking to a psychologist, and I’m pleased to share it here. Please do pass it along if you think it may help someone.

Many people have huge barriers to seeking help when they are struggling. Sometimes these barriers are financial. Some folks may not be in a location in which it is easy to find good care from a variety of providers. Some are unable to find the strength to reach out for help. Some folks want help but they may have difficulty finding a therapist who is sensitive to their cultural needs or who has expertise working with their particular issues.

This is one way that blogging and the Internet can increase access. It is becoming easier to find help, whether that comes through seeking online support or searching for a clinician. Some people are utilizing telehealth services to reach out to practitioners outside of their communities. Others are able to find information and resources shared by others and not feel so isolated.

One of my own practice specialties is working with sexual minority clients who have traditionally been pathologized by mental health professionals. It can be intimidating to seek care for anxiety, compulsive thoughts or behaviors, depression, or relationship concerns if you worry that your therapist will assume that your identity or lifestyle is a cause for concern. If you need help finding a therapist who is knowledgeable and accepting of your kink, poly, or LGBT identity, please see my favorite resources below:

• Kink-aware professionals is a directory to help you find a referrals to psychotherapeutic, medical, legal and other professionals who are knowledgeable about and sensitive to diverse expressions of sexuality.
• Poly-friendly professionals is a list of professionals who have been referred or who have identified themselves as being, open-minded about polyamory and polyamorous issues.
• Gaylesta is a Bay Area, CA resource providing therapist referrals, education, and consultation to LGBTQ clients, but there is likely a similar resource in your community.

For more general information and articles, I recommend people look at what is available at these sites:

• American Psychological Association: browse the psychology topics to learn more
• PsychCentral has become one of the largest and most resourced hubs of mental health information, support, and community on the web.

Lastly, here are two of my favorite mental health news items of this week:

• Self-compassion may matter more than self-esteem explains how developing the skills of mindfulness, common humanity and kindness can improve your mental health.

• If you think it’s hard to take the steps to seek mental health care, it may reassure you to know that the majority of mental health professionals believe in therapy for themselves. At this link, Suzanne Phillips, Psy.D., ABPP shares  some research reporting that 84% of psychologists and 85% of cross-discipline mental health professionals have also sought mental health treatment.

Those who only read the title The Wrong Kind of Talk Therapy or tag line (both written by the Times and not seen by me until the piece ran), may have gotten the false impression that I am against online reviews. I am not. But these sites do need a significant upgrade when it comes to reviewing health care services.

What struck me from the comments is the pain and frustration experienced by consumers of mental health care. Many expressed powerlessness and confusion when it comes both to finding good care and to understanding the process of psychotherapy. Such comments made it clear how important it is for mental health professionals to provide better information to demystify what it is that we do, how we work, and how we can help. It is also incumbent on mental health practitioners and organizations to let consumers know what they can do when they feel that something harmful has occurred in their treatment.

Most often, people simply struggle with a “poor match” when looking for a psychotherapist. It’s certainly hard to find someone who feels like the right fit. But when a clinician is impaired or is doing harm, licensing boards are a useful resource. Consumers can ask questions and make complaints to licensing boards. This is also the place to turn to when you want to verify that a clinician is licensed or if you want to see whether there are any disciplinary actions against a practicing professional. If you are seeking care anywhere, it is wise to choose a licensed professional partly because this means there is a governing body to turn to if something goes wrong.

In my office forms, I let my clients know that my presence on sites like Yelp is not a request for a testimonial, but I do remind them that they have the right to tell anyone about my services and how they feel about them whenever and wherever they wish. This right belongs to them.

For more on this topic, check out John Grohol’s Yelp and Therapist Reviews in which he makes some great points about the lack of reliability of the current rating sites and the problem of there being too many sites out there at this time for consumers to find meaningful data.

From the email:

Psychology Today has recently introduced call tracking and call security
for your profile. People who find you on Psychology Today see a unique
local phone number for you that, when they call it, automatically
connects to your private number.

The email went on to explain that clinicians benefit from this change because it offers us “a simple way to tell who found your profile on the Therapy Directory.” Really? You want to know another really simple way to tell how your clients found you? Try directly asking all new clients how they found your practice. I don’t need the website itself to document patient first contacts in order for me to have this information.

There are a number of problems with this system. First, Psychology Today is used by many people to locate a therapist in their area. But now, clients will not find your actual office number listed. They will see an automatically generated number that Psychology Today has put in place of your office number (as if you would not want clients to know your actual office number!). Then, the site records and documents calls made to our practices without patients being made aware that they are using a third party to connect with us. The call then gets forwarded to our practice phone number and an email summary is sent to us. But the call information also winds up being documented by Psychology Today, including caller ID information and the length of the call. This information is also stored on the Psychology Today site when you log into your account.

This is a serious potential breach of privacy and I object to this service being something I was automatically signed up for, without my consent. On a recent listserv discussion, many therapists had not even received a notification that this change had been made.

In order to opt-out of the virtual phone number, you must log into your Psychology Today account account and click the option in ‘Contact History’. I did this and I recommend others do so if you care about who else retains records of who calls your office or if you want clients to be able to save your actual phone number from the site.

For what it’s worth, Psychology Today also records the information of those who choose to email you from their site. I much prefer that if clients want to make direct contact with me, they use my secure form or phone my office directly without an advertiser acting as the middle man and collecting data on those who wish to use my services.

Update: 8/5/10

For those who want to know more about what it looks like when Psychology Today sends these emails, I phoned my own virtual number. As a caller, it sounded just as if I was calling my regular office line. No information or announcement let me know that my call was being routed through a service. After the call, I received the following email:

Hi Keely Kolmes,

At 09:21 AM PDT you received a phone call. This caller found you on PsychologyToday.com.

Call to (415) 501-9098
Call from Caller ID Blocked
Date: August 5, 2010
Call Duration: 00:00:06

To view a record of this call, please log into your profile and click on the Contact History tab.

FAQs:-

WHY AM I GETTING THIS CALL CONFIRMATION?

Psychology Today has recently introduced call tracking and call security
for your profile. People who find you on Psychology Today see a unique
local phone number for you that, when they call it, automatically
connects to your private number.

WHY DO I BENEFIT?

1: It’s a simple way to tell who found your profile on the Therapy
Directory.

2: You get a record of the people who have called you (Check ‘Contact
History’ when you log in).

3: Spam phone calls from telemarketers are filtered out – about 99% such
calls can be screened.

To opt out of receiving these call confirmation emails, log into your
account and click the option in ‘Contact History’.

—
The folks at PsychologyToday.com
—

*Don’t reply to this email*

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) Additional comments on documentation for clinicians. Retrieved month/year from http://drkkolmes.com/2010/08/05/psychology-today-introduces-new-call-tracking-raises-privacy-concerns/

The NCSF is committed to creating a political, legal and social environment in the US that advances equal rights for consenting adults who engage in alternative sexual and relationship expressions. The NCSF aims to advance the rights of, and advocate for consenting adults in the BDSM-Leather-Fetish, Swing, and Polyamory Communities. They do this through direct services, education, advocacy, and outreach, in conjunction with their partners, to directly benefit these communities.

Read a snippet from NCSF’s press release below.

NCSF Publishes Important Information for Your Mental Health

NCSF and the NCSF Foundation are proud to announce two new and valuable publications: A Guide to Choosing a Kink-Aware Therapist, and the Therapists Guide to Polyamory.

A Guide to Choosing a Kink-Aware Therapist , created by Keely Kolmes Psy.D. and Geri Weitzman Ph.D., will help people who engage in BDSM find a therapist who can accept them without judgment or prejudice. Some therapists cause more harm than good when they slap a label of mental illness on a client simply because they enjoy kinky sex.

“Over the years, I have received many calls from folks around the globe who wanted access to therapy that was respectful of their kink identity, but didn’t know where to turn to find it,” says co-author Geri Weitzman, PhD. “We are excited to share this resource on finding kink-aware therapists with our community, in the belief that a warmly accepting therapeutic environment should be available to all.”

“Therapy needs to be a place where you can feel safe to bring your whole self. I hope that our article is a helpful tool for kink-identified clients and the therapists who want to learn more about working competently with them,” agrees co-author Keely Kolmes, Psy.D.

NCSF has also published second paper for therapists: A Therapist’s Guide to Polyamory. This resource can also be found on their site.

If you are a current client, I will update you on the changes and have you sign a new Acknowledgment of Notifications form to indicate that you are aware of these changes when we next meet.

Please note that since this original blog post, I have updated my Social Media Policy to include information about location-based check-ins and some other items not mentioned on this page. You are welcome to download the current document.

Other clinicians may copy, share, or adapt this policy to suit your own practice needs, but you may not use this work for commercial purposes. If you use my policy for training or educational purposes, please cite me as the original author.

Thanks to everyone who provided feedback on my first draft. I have slightly modified some sections and added a bit more to this document. I realized that some sections needed a bit more explanation so that clients would understand my rationale for my practice choices. When this policy is final, I will upload it to my forms page and print it up for current clients. As before, I invite anyone to copy or modify this form for their own practice.

This document outlines my office policies related to use of social media. Please read to understand how I conduct myself on the Internet and how you can expect me to respond to various requests and interactions between us.

If a time should come when I revise any of these policies, I will bring an updated copy of this form to our session so that you are aware of any changes.

If you have any questions about anything within this document, I encourage you to bring them up when we meet.

Friending

I do not accept friend requests from current or former clients. This holds true on Facebook, LinkedIn, and all other social networking sites. My reasons for this are that I believe that adding clients as friends on these websites can compromise confidentiality and blur the boundaries of our therapeutic relationship. If you have questions about this, please feel free to bring them up when we meet and I’m happy to talk more about it.

Fanning

I maintain a Facebook Page for my professional practice. I use this Page to allow colleagues to share my blog postings and practice updates within Facebook. All of these articles are also directly available on my website.

While you are always welcome to visit my Facebook Page and read or share articles posted there, I do not allow clients to become Fans of this Page. I believe having clients as Fans of this Page creates an even greater likelihood of compromised client privacy and I do not want others who may look through my list of Fans to find any clients listed. In addition, it is a violation of my professional ethics code to solicit testimonials from clients. I feel that the term “Fan” implies a request for a public endorsement of my practice.

If you are my client and I see that you have become a Fan of my Facebook Page, you can expect me to discuss this with you in-session and request that you remove yourself from my Page. If it will be awhile before our next scheduled meeting, I may remove you myself and I will discuss it with you during our next session.

Please note that you can subscribe to the page via RSS without becoming a Fan and without creating a visible, public link to my Page. You are welcome to do this.

Following

I currently maintain a professional Twitter stream. If you use an easily recognizable (to me) name on Twitter and I notice that you’ve followed me there, you can expect me to bring it up in therapy so that we can briefly discuss it.

My primary concern will be your privacy. There are more private ways to follow me on Twitter (such as subscribing using an RSS feed or using a locked Twitter list), which would eliminate your having a public link to my content. But you are welcome to use your own discretion in choosing whether to follow me. There is nothing I post here that I would not want you to see.

Please note that I will not follow you back.

I do not follow current or former clients on blogs or Twitter. If there are things you wish to share with me from your online life, I strongly encourage you to bring them into our sessions where we can process them together, during the therapy hour.

Interacting

Please do not use messaging on websites such as Twitter, Facebook, and LinkedIn to contact me. These sites are not secure and I may not read these messages in a timely fashion. If you need to contact me between sessions, the best way to do so is by phone. Direct email at drkkolmes [at] gmail is second best for quick, administrative issues such as changing appointment times. Please see the email section below for more information regarding email interactions.

Use of Search Engines

It is NOT a regular part of my practice to search for clients on Google or other search engines. Extremely rare exceptions to this may be made during times of crisis. If I have a reason to suspect that you are in danger and you have not been in touch with me via our usual means (coming to appointments, phone, or email) there may be a circumstance in which using a search engine (to find you, find someone close to you, or to check on your status) becomes necessary as part of ensuring your welfare. These are extremely rare situations and if I resort to such means, I will document it and discuss it with you when we next meet.

Google Reader

I do not follow current or former clients on Google Reader. I also do not use this account to share articles with current or former clients. I share many links of interest via my Twitter account, which you are welcome to read. If there are things you want to share with me that you feel are relevant to your treatment, I encourage you to bring these items of interest into our sessions.

Business Review Sites

There are a number of different websites including Yelp and Healthgrades, on which you may find my practice information. Many of these sites comb search engines for business listings and automatically add listings. If you should find my listing on these sites, please know that my listing on any of these sites is NOT a request for a testimonial or endorsement from you as my client.

The American Psychological Association’s Ethics Code states under Principle 5.05 that it is unethical for psychologists to solicit testimonials: “Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.”

Of course, you have a right to express yourself on any site you wish, but due to confidentiality, I cannot respond to any review on any of these sites whether it is positive or negative. I urge you to take your own privacy as seriously as I take my commitment of confidentiality to you.

If we are working together, it is my hope that you will bring your feelings and reactions to our work directly into the therapy process. This can be an important part of therapy, even if you decide we are not a good fit. If you still choose to write something on a business review site, then please remember this is a public forum on which you could be sharing personally revealing information. I urge you to create a pseudonym that is not linked to your regular email address or friend networks.

Lastly, none of this means that you cannot share that you are in therapy with me wherever and with whomever you like. Confidentiality means that I cannot tell people that you are my client and my ethics code prohibits me from requesting testimonials. But you are more than welcome to tell anyone you wish that I’m your therapist in any forum of your choosing.

Email

I prefer to use email only to arrange or modify appointments. Please do not use email to send content related to your therapy sessions, as email is not completely secure or confidential. If you choose to communicate with me by email, please be aware that all emails are retained in the logs of your and my Internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the Internet service provider. You should also know that any email I receive from you and any responses that I send to you will be printed out by me and kept in your treatment record.

Please note that this is currently a work in progress. There may be important things to add to this policy, but this is my first draft. If you have any comments or suggestions or think something is missing, please directly email me.

Also, anyone is welcome to use or adapt this form to your own practice. I know that many practitioners adopt different stances than my own when it comes to how they manage clinical care and their social media policy. Please consider making your own policies readily available to your clients so that it is clear and documented, even if your approach is to take it case-by-case.

Friending

I do not accept friend requests from current or former clients. This holds true on Facebook and LinkedIn and all other social networking sites. My reasons for this stance are that I believe that adding clients as friends can compromise confidentiality and blur the boundaries of our therapeutic relationship. If you have questions about this, please feel free to bring it up in-session and I’m happy to talk more about it.

Fanning

I maintain a Facebook page for my professional practice. I do not allow clients to become fans of this page because I believe there is an even greater likelihood of compromised client privacy and I do not want others who may look through my fans to assume you are my client.

If you are my client and I see that you have become a fan of my Facebook page, you can expect me to delete you as a fan and bring it up in our session when I see you next.

Please note that you will always be able to view all my Page content without becoming a fan or you can subscribe to the page via RSS without creating a visible, public link to my Page.

Following

I currently keep a professional Twitter stream and a blog on my practice website. If you use an easily recognizable (to me) name and I notice that you’ve followed me on Twitter, you can expect me to bring it up in therapy so that we can briefly discuss it.

My primary concern will be how it relates to your own privacy. There are more private ways to follow me on Twitter (such as subscribing using an RSS feed) which would eliminate your having a public link to my content. But you are welcome to use your own discretion in choosing whether to follow me. There is nothing I post here that I would not want you to see.

Please be aware that I will not follow you back.

I do not follow current or former clients on blogs or Twitter. If there are things you wish to share with me from your online life, I strongly encourage you to bring them into our sessions where we can process them together, during the therapy hour.

Interacting

I do have a professional presence on Twitter, Facebook, and LinkedIn. I also keep a blog. You are always welcome to read my content on these sites if it is of interest to you. But please do not use these sites to send me messages or to interact with me outside of treatment. If you need to contact me between sessions, the best way is by phone. Email is second best, but only for quick, administrative issues such as changing appointment times. Please see the email section below for more information regarding email interactions.

Use of Search Engines

It is NOT a regular part of my practice to search for clients on Google or other search engines. Exceptions to this may be made during times of crisis. If I have a reason to suspect that you are in danger and you have not been in touch with me via our usual means (coming to appointments, phone, email) there may be a circumstance in which using a search engine to find another party close to you or seeing if you have or have posted to a blog, Facebook page, or Twitter may become necessary as part of checking on your welfare. These are extremely rare situations and If I ever resort to such means, I will definitely discuss this with you when we next meet.

Google Reader

I do not follow current or former clients on Google Reader. I also do not use this account to share articles with current or former clients. I share many links of interest via my Twitter account which you are welcome to read and I encourage you to bring your own items of interest into our sessions if there are things you want to share with me that you feel are relevant to your treatment.

Email

I prefer to use email only to arrange or modify appointments. Please do not use email to send content related to your therapy sessions, as email is not completely secure or confidential. If you choose to communicate with me by email, please be aware that all emails are retained in the logs of your and my internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. You should also know that any email I receive from you, and any responses that I send to you, will be printed out by me and kept in your treatment record.