Please join our group: Bay Area Therapists Affirming of Diversity in Sexuality

This is a free group for mental health professionals in the Bay Area of California. We offer support, networking, and consultation for Bay Area clinicians and mental health trainees who embrace the full range of sexual expression of consenting adults. Our respective practices explicitly welcome and serve clients who engage in alternative sexual behaviors and relationships, including kink and poly folks.

We offer an email list and meet every other month at a member’s office.

We are especially interested in reaching out to students who may not have mentors or support in their clinical programs around working with sexually diverse populations.  Most clinical programs encourage students to explore their cultural identities and offer student groups organized around ethnicity, religion, LGBT-identity, disability, or other cultural affiliations.

But students who are kink or poly-identified or who want to work with these populations may have a more difficult time identifying one another and forming such groups. Many schools still don’t recognize these alternative identities as deserving of non-biased care and respect. We are seeking to bridge this gap. We offer a safe space to connect with other mental health professionals who are affirming of the full range of diverse sexual expression.

Contact me at drkkolmes at hushmail dot com if you would like to get connected with us.

One post by Heidi N. Moore, Facebook to Privacy: Drop Dead, accurately referred to it as a “bait and switch,” and addressed why reporters may wish to keep their friend lists private. Joseph Bonneau, a security researcher, wrote Facebook Tosses Graph Privacy Into the Bin, about why friend lists should be regarded as sensitive data. And then there is Kevin Bankston of EFF’s post Facebook’s New Privacy Changes: The Good, The Bad, and The Ugly.

Since the initial changes were made, Facebook has added back the ability to hide your friend list from other users. Nevertheless, in some of my exchanges with other mental health professionals, the option of blocking users has come up more than once as a means of ensuring greater privacy. Before last night, I had never tried using the Block feature on Facebook, as the original privacy settings had met my needs well. I experimented with it yesterday and it does seem to be a useful way to restrict access to one’s profile and I can see some benefits to using it in certain situations.

That said, I have some strong objections to relying upon the Block feature as a means of restricting access to profiles, particularly when health care providers use it to Block patients.

Does it work?

My first concern is technical: blocking particular email addresses assumes that you know which email address a person is using to access their Facebook profile. Many users link multiple email addresses to their Facebook accounts, so blocking the email address you know does not completely ensure that someone doesn’t have access to you. It also doesn’t address users who have used one email address to contact you but have their mail forwarded to another address. These users may still be able to view your profile when using an email address with which you are not familiar.

More privacy infringement

My second issue is related to overall privacy violations: forcing users to choose the Block feature as the only way to restrict others’ access to their profile is simply another means of collecting data. Typing names into a Block list is one more infringement on personal privacy. When we do this, we are providing specific information to Facebook about people and saying something about our connections to them. This is much more information than I care to provide to Facebook when there is a much easier way to restrict access that does not entail my providing the company with information about my specific relationships.

Our own commitment to client privacy

Just as we expect Facebook to honor our privacy, our clients expect us to do the same. As an issue of professional ethics, it seems to me to be a violation of patient privacy to enter client names and/or email addresses into Facebook unless that is specifically indicated in our treatment contracts.

My current treatment agreement states that I keep patient information private and do not share it with others unless there is reason to believe that the patient or another individual is at risk. My policy does not indicate that I may also share client information with Facebook. It is easy to forget that when we type names into a search engine or a field on a social network, we are also sharing information with others. Doing so without, at the very least, informing our clients seems to be a breach of trust.

However, if Facebook continues to make it impossible for us to restrict profiles to users of our choosing, those of us who wish to continue using the social network in our private lives may find Block to be a useful feature. If I ever decide to employ it on my own Facebook profile, I will include a statement about this in my Social Media Policy, so that clients are aware that I do this and why. Clinicians who are already Blocking clients may wish to consider explaining that they do it not only to prevent clients from stumbling onto their interactions with others, but also to prevent therapists themselves from seeing their clients’ personal interactions with shared friends if they should have overlapping social circles.

That said, I’d greatly prefer that Facebook just do the right thing and allow their users to have back the greater control over profile privacy that they enjoyed up until just a few days ago.

References

Bankston, K. (2009, December 9) Facebook’s New Privacy Changes: The Good, The Bad, and The Ugly. Retrieved December 11, 2009 from http://www.eff.org/deeplinks/2009/12/facebooks-new-privacy-changes-good-bad-and-ugly

Bonneau, J. (2009, December 11) Facebook tosses graph privacy into the bin. Retrieved December 11, 2009 from http://www.lightbluetouchpaper.org/2009/12/11/facebook-tosses-graph-privacy-into-the-bin/

Kolmes, K. (2009, December 10) How Facebook is Getting it Wrong: New Privacy Settings Offer Less Privacy. Retrieved December 11, 2009 from http://drkkolmes.com/2009/12/10/how-facebook-is-getting-it-wrong-new-privacy-settings-offer-less-privacy/

Kolmes, K. (2010, February 1) Private Practice Social Media Policy. Retrieved April 26 2010) from http://www.drkkolmes.com/docs/socmed.pdf

Moore, H. (2009, December 10) Facebook to Privacy: Drop Dead. Retrieved December 10, 2009 from http://www.thebigmoney.com/blogs/sausage/2009/12/10/facebook-privacy-drop-dead

Muller, A.Y. (2009, December 9) Updates on Your New Privacy Tools. Retrieved December 11, 2009 from http://blog.facebook.com/blog.php?post=197943902130

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) Should mental health professionals block clients on Facebook? Retrieved month/day/year from http://drkkolmes.com/2009/12/11/should-mental-health-professionals-block-clients-on-facebook/.

So let’s think this through. First, on the surface, it can seem that LinkedIn might be a reasonable space on which to accept requests from clients. Afterall, it is a professional context, so it’s not as potentially confusing as adding a client on a network that is used primarily for sharing personal photos or tidbits. We are in our professional role on this site. On the other hand, it can blur the boundaries of the clinical relationship. It also creates a visible and public connection to someone with whom we are supposed to be in a confidential relationship. Two of our primary commitments to clients are providing confidentiality and avoiding multiple relationships that could cause harm (APA, 2002).

Some would say that simply listing someone as your contact doesn’t compromise confidentiality in and of itself or create multiple roles.

But consider the following scenario:

Your former client, Linda, sends you a request to connect on LinkedIn which you decide to accept. You rarely go onto the site, so you don’t really think about it much until four months later, when Linda sends you a message requesting that you make an Introduction to your friend, Tom, who she sees in her LinkedIn network. Linda is looking for a job at Company X and she sees that Tom, your 1st degree contact, works there.

What should you do? Ignore Linda’s request? Make the introduction? What if Tom wants to know how you know Linda? Even if Linda says it’s okay, this does not mean it’s okay to reveal that she was in treatment with you.

What if you refuse Linda’s request? Do you want to call her and discuss this? Reply via email?

What if Linda asks you to write a recommendation for her on the site? What if instead of Linda making the request, one of your other business contacts asks you to make an introduction to Linda? What if his interest is more personal and he just wants to ask her out? What if his interest is specifically about business? Would you do that? Would you be comfortable asking Linda to help your friend get a job at her company?

While a scenario like this may seem unlikely, it’s easy to see how quickly an innocent click of the mouse can turn what was once a therapy relationship into something more complex. It’s trickier too, when requests are made by former clients, since we are not typically in the position of being able to explain to them why we decline a request, if we do so. And, obviously, our commitment of confidentiality extends beyond the termination of the therapy relationship.

It’s good to remember that the purpose of LinkedIn is to engage in business networking. Most therapists do not include making job introductions as part of their practice with clients. If you are someone who would not typically do this in your offline practice, then adding a client on this site is unwise. Some clinicians, however, feel strongly that having across-the-board policies is at odds with how they work. Some may feel more comfortable deciding who to add on a case-by-case basis, and there may be scenarios in which it could be argued that making the connection serves the clinical work in some way.

What do I recommend? While I appreciate the thoughtfulness and care that can go into making decisions on a case-by-case basis, doing this also opens the door to risk in terms of professional liability and the possibility of damaging therapeutic relationships. Suppose a former client experiences feelings of rejection when you decline her contact request, but she then discovers that you went ahead and accepted her friend’s request? This is why having a clear policy about how you handle contact requests and communicating this to your clients (via Social Media Policies and Consent to Treatment forms) is important. My own policy is not to add current or former clients as contacts on any social media site.

Some last considerations for psychotherapists using LinkedIn are issues related to your privacy. There are a number of settings that you can adjust on the site, including whether you wish make your list of contacts available to all connections who are browsing your profile or to no one. If this is information you’d like to keep private, you go to the Settings on your profile, go to Privacy Settings, and select Connections Browse. Here you have the option of hiding or showing your connections list.

Another privacy setting that you may adjust is whether people can see if you’ve browsed their profiles. You change this setting under Privacy Settings > Profile Views, where you may choose whether to show your name, just your industry and title, or to remain completely anonymous. Lastly, under Profile > Profile Settings, you can to go Public Profile to choose whether or not to let your profile show up on search engines. Be aware that many aggregator sites can link your business profile to your social profiles on other social networking sites, merging your online identities, based upon matching the people in your friend network. If you maintain a pseudonym for your personal life, you might prefer to keep these identities dissociated by keeping your business network off of search engines.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) LinkedIn for mental health professionals. Retrieved month/day/year from http://drkkolmes.com/2009/11/16/linkedin-for-mental-health-professionals/.

More about my motivation for this can be read below.

Recently, I’ve had the opportunity to reflect on my experience as a graduate student doing research on kinky sex. Taking on therapist bias against BDSM as a dissertation topic was challenging. I frequently felt misunderstood or I worried that professors and other students might make assumptions about my sexual practices. When I wasn’t busy worrying about those things, I worried about the burden of responsibility that I suddenly felt to the BDSM community, by virtue of choosing this topic. I went back and forth several times and nearly changed my topic to something….less adventurous.

However, I’d had the experience in my early 20′s of discovering books and friends who taught me that BDSM wasn’t the terrible, dirty thing I had once assumed it was. I learned that it was actually something that could be about trust, love, safety, and consensuality.

I had my mind changed.

Thus, with the earnestness and conviction that can only come from having your own prejudices revealed to yourself, I took on the issue as a personal challenge to myself, and eventually completed my dissertation on BDSM. This also meant that I experienced anxiety and dread in anticipation of every class I took over the next five years, as it was standard protocol to introduce yourself and your dissertation topic on the first day of every first class each semester.

Of course I hoped that my doing research in this area might mean that it would help reduce bias for BDSM clients entering therapy one day. But I also dreamed that psychology graduate students who identified as kinky or poly might also feel safer as they navigated graduate school or at least feel that the profession had become more welcoming.

It’s now thirteen years since I started my graduate training, and I’ve recently heard from students in training programs who do not feel that their programs adequately provide support or mentoring for developing clinicians who identify as kinky and/or poly or who simply wish to work with those populations.

Most programs these days encourage students to explore their cultural identities and they have student organizations allowing students to connect around ethnicity, religion, LGBT-identity, disability, or other cultural affiliations. But students who are kink or poly-identified may have a more difficult time identifying one another and forming such groups. Students struggle with how–and whether–to come out in a professional capacity either as members of the kink or poly communities themselves or as simply having knowledge or interest in serving these populations. Many schools still don’t recognize these alternative identities as deserving of support or outreach.

My support/networking/consultation group for Bay Area kink/poly-aware clinicians would allow students from various training programs to meet and network with one another and also allow them to connect with those of us who are already established as kink & poly aware professionals.

Smart Women provides a space for women in business and their friends to gather, socialize, and share business ideas while enjoying drinks and appetizers. It’s relaxed and friendly, and it’s a great place to make personal and professional connections. Most of the attendees are subscribers and contacts of “Betty’s List,” an online information service for the San Francisco Bay Area’s LGBT community.

I will speak briefly about my psychotherapy practice and current projects and I will answer your questions. I will also lead the “Shout Out!” activity in which each attendee has the chance to introduce herself and her business.

The event is free to members of the Betty’s List directory and non-members can attend for $10.00. If you want to meet other business women, you want to know more about psychotherapy, or you just wanted to meet me, please come out and join us.

I’m looking forward to meeting you!

While I had been using Twitter socially since 2006, it hadn’t occurred to me to create a professional Twitter presence until just this year. In just a few months, I have been able to connect and engage with so many people around the psychology issues I’m most passionate about. It’s been an incredible resource for me and has allowed me to have so many interesting conversations and collaborations with people. In fact, I get so much out of it myself, that it’s very easy to forget that others find value in what I post.

If you’re a mental health professional who is interested in using Twitter, you may want to read my post Managing Twitter as a Mental Health Professional. Plenty of us are already there having conversations about mental health issues and we would love to connect with you.

Speaking of the others who are already connected on Twitter, I am especially delighted to be in such great company with the other top ten. If you’re interested in psychology tweets, you should definitely be following these folks too. Links to them are here and here.

In my last installment on social media for mental health professionals, I spoke about how to manage Twitter. Now we move on to Facebook which gets a little bit more complicated.

Many therapists are not even on Facebook or they may not fully understand why so many people use it. To be brief, Facebook is a social networking site that allows folks to connect to their friends and interact with them (and their online content) in a variety of ways.

If you are a therapist who does not consider yourself tech-savvy and you’re already on Facebook, you may have been invited by a former classmate or a family member who wanted to share photos with you. Or perhaps a co-worker invited you so that you could play games or see photos from your clinic’s holiday party. This is exactly how Facebook can get dicey for mental health professionals. Facebook is a social space which can quickly overlap into our professional lives making it harder to distinguish between personal and professional activities. Maybe that’s where I should begin.

Personal vs. Professional Roles

As mentioned in my Twitter article, it’s important to consider your purpose in using social networking sites before joining each one. The Introduction to our APA Ethics Code (APA, 2002) for psychologists states that the code is only applicable to our activities when they are part of our scientific, educational, or professional roles. But popular social networking sites make the distinction between personal and professional activities less and less clear. Stephen Behnke (2008) discusses the challenges of defining “private” in the age of the Internet and the difficulty in assessing the impact of events from one’s personal life on one’s work related activities.

Facebook and other social networking sites which allow us to “friend,” friends, families, and co-workers alike, are creating unique challenges for mental health professionals. It is tricky enough if our profiles are simply visible to our clients. But if clients or colleagues invite us to become “friends,” on these sites, or we extend those invitations to them—even by accidentally clicking on a link to invite everyone in our address book—the boundaries can quickly become even more complicated.

If you are using your Facebook profile to establish your professional identity or to attract, connect, and interact with potential or current clients and colleagues, your Facebook presence is already part of your professional space. Accepting client requests to “friend” you can be perceived as an extension of your professional practice. Remember that professional relationships come with legal and ethical responsibilities which do not cease to exist just because you are on a social networking site.

Inviting clients to your personal profile can also be perceived as inviting them into your personal life. Unless you utilize very strict privacy settings on your profile, those who become your “friends” can post and view messages posted to your Wall, they can view your photo albums and read the comments on these albums, and they can see and interact with your other “friends.”This can send mixed messages to clients, especially if they are unclear about therapeutic boundaries to begin with. If you would never think of inviting a client to a cocktail party at your home with your friends and family present, then you may want to think twice about inviting them to be your friend on Facebook (or approving their friend requests). It is the online equivalent of inviting them into your social circle.

Visibility, Exposure, and Self-Disclosure

Another challenge that comes with Facebook is that it is not even necessary for us to add or accept a person’s friend request in order for either party to glean a great deal of information about the other. If you choose to have a public Facebook profile and you do not employ any privacy settings on your Wall, this means that your clients on Facebook can see anything that you make visible on your profile, including comments made by friends and family. They do not have to be connected to you as a friend in order to view this information. With no privacy settings selected, people can see when you are on the site, when you are tagged in photos or videos, and they can view any other activity that is visible on your profile, including status updates, any games and applications you add, and personal shout-outs on your wall.

Zur, et al., (2009), discuss the various levels of self-disclosure that psychotherapists engage in with clients. Therapist self-disclosures may be deliberate or non-deliberate, verbal or non-verbal, and avoidable or unavoidable. The authors point out that therapists should be aware that all of their online postings, blogs, or chats may be viewed by clients and that these archives will stay online in some format, forever. Psychotherapists with public Facebook profiles need to be mindful that some clients will see their profiles and they should consider the impact that this information could have on their clinical relationships. It may be helpful to consider when reading your profile whether any of the information contained in it is something you would disclose to each of your therapy clients. If not, you may wish to delete information or re-evaluate your privacy settings.

Another type of disclosure that Facebook makes available to clients is information about who your friends and family members are. While it’s true that there have likely always been just a few degrees of separation between many of our clients and ourselves in the past, Facebook these previously invisible connections instantly accessible. Facebook will even go further, suggesting friends to you because you happen to have friends in common with another user. If you click on the profile of such a user, it neatly list the names of each of the friends you share, as seen below.

Imagine how you may feel discovering that you and your clients have mutual friends. What if it’s two friends in common? What if it’s twenty? You may have your own varied reactions to having access to this information, but imagine how your client may feel when she discovers the same thing. Some clients may not be troubled by this information, but others may find it disturbing. Access to this information alone may quickly change one’s perception of the clinical relationship. While it may not impair your objectivity as a clinician, it may subtly influence how you regard your patient in a multitude of ways, and it may also have an impact on how your patient views you and your relationship.

Some therapists are managing these challenges by employing the most restrictive privacy settings so that very little of their profile is visible to those who are not their friends. Others are using different names than the ones they practice under to distinguish their personal, social Facebook profile from their professional identity. Others have responded by entering client names into Facebook’s “Block” feature, in an effort to prevent clients from stumbling onto their profiles. For more on this, please see my article, “Should Mental Health Professionals Block Clients on Facebook?”

Thinking Clinically

The APA Ethics Code (APA, 2002), Standard 3.05, Multiple Relationships, states that psychologists should avoid multiple relationships that could impair their effectiveness or cause harm. Therapists would do best to avoid entering into any multiple role with their clients if it could be seen as counter to therapeutic goals and client well-being. Levahot (2009) points out, however, that client requests to add us as friends also raise opportunities for us to explore issues related to trust, relationships, and boundaries, even if we ultimately decide not to grant the request. It can certainly provide a window for explaining to clients the difference between social relationships and professional ones. It can also create a space to explain how we protect client confidentiality. This can be an extremely beneficial conversation to have with a client.

However, let’s say you decide you would like to be friends with some of your clients on Facebook. Perhaps you work within a theoretical orientation in which a more egalitarian stance is desired by you. Or, maybe rather than having a strict policy of not friending clients, you would prefer to make those decisions on a case-by-case basis, considering whether there is a clinical rationale to support the decision for some of your clients. Aside from making your own online activities and relationships visible to your clients, this now means that your client’s activities on their profile will likely be showing up in your news feed.

Do you want to get updates on your clients’ lives out of session, knowing before their scheduled session with you what kind of day they’ve had or that their relationship status has changed or that they were out heavily drinking at a party last night? Or would you prefer to hear news about your clients lives directly from them in-session? Might there now be some expectation that you will keep abreast of changes in their lives on Facebook in-between sessions? What if a client expresses self-harm desires on her Facebook Wall? If you fail to act on cries for help on a Facebook page and your client harms herself or someone else, could you be professionally liable for failing to prevent harm? These are questions that therapists will have to consider when they establish online connections with patients.

And what if you change your mind? What if you decide you want to use your Facebook profile differently or you come to believe that it was a mistake to friend the client and it is no longer in their best clinical interest? I have met with clinicians seeking consultation with me because they accepted friend requests from clients and later realized they regretted this decision. Deleting a client as a friend can be experienced as especially rejecting and complex—more so than declining the initial friend request in the first place. These are certainly thorny ethical and clinical dilemmas which require consultation and care.

Interaction and Legal Responsibilities

In Patricia R. Recupero’s article, “Legal Concerns for Psychiatrists Who Maintain Websites,” she outlines how courts recognize three types of websites. There are passive sites which provide basic business information and which act like home pages or advertisements. Second, there are business sites on which business is conducted. Business sites are highly interactive and are utilized for commercial transactions. Third, there are intermediate sites which are more interactive but do not involve financial transactions. Intermediate sites may offer advice and may invite contact from site visitors.

As Recupero explains, intermediate sites inviting contact from site visitors may lead to unintentional doctor-patient relationships which create legal duties. Many practitioners who do not consider themselves web-savvy enough to create their own websites may wind up with Facebook profiles which are easier to establish and maintain. Some clinicians may use their Facebook profiles to advertise their practices. Be mindful that if you are creating a Facebook page or profile to promote your practice and you enable activity and interaction from clients on your Wall, you are turning your Facebook presence into an intermediate site. This can create potential legal dilemmas for mental health practitioners, as the interaction will need to be consistent with professional standards of care. It also means that you could be having public interactions on the site with people who later become clients which raises additional issues related to confidentiality and HIPAA related communication protocols.

Setting Up Privacy Settings

So does this all mean that you should just forget about Facebook entirely? Not necessarily. It’s possible to enjoy the benefits of Facebook while still protecting your clients and your practice. There are a couple of great resources that provide a step-by-step walk-through in setting up your privacy settings on Facebook. Be aware that some of the privacy features have changed since these original posts were written, so some information may be outdated. You can check these sites for updates to the original posts.

Another option is creating a Facebook profile which is almost completely hidden (it can be hidden in searches but will still show up in the friend lists of those you are friends with, and it may come up in Friend Finder for those with whom you’ve exchanged email in the past). You can also utilize Facebook’s privacy settings to make the content of your profile visible only to people you add as friends. I highly recommend employing the most conservative privacy settings and being mindful of what you post on the Walls of your friends, if you want to maintain a private life on Facebook.

You can also set up your profile so that clients can find you, but they cannot view your full profile. You could also make it possible for people to see a basic page with your name and photo, but you can post a statement that you do not accept clients as friends, and you can disable the ability for those who are not your friends to send you messages on Facebook. You can have settings so that only friends can send you messages, but Facebook no longer allows you to block friend requests from people you don’t know. Now you can limit it only as much to “Friends of Friends,” which is a disappointment for many who do not want anyone connected to a friend of theirs to be able to add them as a connection.

The privacy settings I most frequently recommend to therapists are removing yourself from searches, making your friend lists private, selecting “only me,” on the ability to view tagged photos and videos (and regularly removing tags), and making sure that your contact information is not visible to people you do not want to see it. You should definitely utlize Friend Groups if you are connecting to people from different aspects of your life. If you do this, you can restrict certain parts of your profile so that certain groups (e.g., “Work Contacts,” “People I Met Once,” etc.) cannot view them.

As referenced above, some clinicians enter the email addresses of clients who regularly email them into the Block List on the Privacy Settings page, to avoid the inadvertent discovery of their profiles by clients. But this assumes clients use the same email address on their Facebook profile that they have used to email you which is not always the case.

Profiles vs. Pages

There is another way to use Facebook to promote your practice while keeping your more personal activity under wraps. Facebook offers businesses the ability to create a page instead of a profile. You must first create a profile in order to create a page. But you can keep your actual profile (along with your friendships) private while still having a public page on Facebook. This will allow you to advertise your practice and post links to your blog posts or other professional activities.

One advantage to having a Facebook business page is that you can make this strictly business-related and use it to make announcements related to your practice. This enables other Facebook users to easily share your postings with their friends. People may still link to your page, but the difference is that this is a one-way endorsement, as opposed to a two-way friendship link. This means that people show up as “liking,” your page, instead of being “friends” of yours. More importantly, you are not endorsing a particular relationship with them.

For your own protection, I’d advise disabling or at the very least, carefully monitoring Wall posts made by those following your practice, to reduce legal risks that could follow from people interacting with your page. You should be careful about responding to requests for clinical advice on your Wall and be aware that depending upon how you respond, you could be entering into interactions that establish a professional relationship.

Also, if a client does wind up “Liking” your page, you can always discuss this choice with them in-session and acknowledge the potential impact it could have on them. Of course clients have no duty to be private or confidential about their relationship with us, and some of them may feel comfortable with a public link to our pages, or even saying in public that they are our clients. That is their prerogative. But it does not relieve us of our own duty to provide confidentiality to them. For clients who are interested in following your page, you may wish to remind them that they can follow the activity of your page privately by subscribing to SMS or RSS updates. This will notifiy them of new postings without their having to create a public link to the page.

Technical Loopholes

If you do wind up trying to employ Facebook’s ever-changing privacy settings, note that all your privacy measures can be meaningless if you wind up interacting frequently on other users’ walls. While you can set up your profile so that people have limited access to your own profile, activities that you engage in on other users profiles will still be visible. So if you have friends in common with any of your clients, they will see all of your postings to their friend’s walls connected to your name. If your friends do not lock down their Walls with the same privacy settings you do, then anyone looking at their profile may view this information.

You will have to use your best judgment as to how you want to interact in a public and regularly archived space.

Also if you decide that you do want to accept friend requests from clients, know that it is fair for them to assume that some of your other “friends,’ may be clients, as well. This could potentially raise concerns about client confidentiality. As with Twitter, you should also be aware that you cannot guarantee the confidentiality of any messages sent to you via Facebook and these exchanges are not HIPAA compliant.

If you have ever emailed with a client, take heed that you may each be showing up in one another’s Find Friend searches. It can be all too easy for either one of you to accidentally invite all your mail contacts with a careless click of the mouse. So be aware that friend requests in either direction may have been accidental.

Final Thoughts

As the internet evolves and more clients and therapists are sharing online social spaces, we have the opportunity to think critically about how we use online spaces personally and professionally. It is becoming important for all of us providing clinical care to consider the kind of access we want to permit others (especially clients) to have to our online profiles and the access we have to our client’s lives online. It is especially important to consider not only the impact our private lives are having on our professional activities, but also how we present our professional identities on sites like Facebook which so easily blend the two.

Professional Consultation

The internet is creating new ethical challenges for many of us. If you are a therapist who is seeking further consultation regarding technical, clinical, or ethical issues related to internet technology and your therapy practice, it may make sense to consult with a professional with expertise in this area, or someone who can help you to secure and test your privacy settings. This can be a wise investment.

Update June, 17, 2010

Since the first publication of this post in June, 2009, Facebook has made a number of privacy changes.

In December 2009, there was a major privacy update which made it impossible to completely hide your profile. While it used to be possible to keep your profile from being shown to anyone who was not your friend, this is no longer an option. You can still hide your profile from general searches on the site, but now anyone can navigate to your profile if they know one of your friends, and if that friend does not hide their friend list. Another way for users to navigate to your profile is if you share “Likes,” or “Interests.”

In April, 2010, Facebook launched Instant Personalization and forced users to make their “Likes,” and “Pages,” public. Following a number of criticisms, Facebook brought back some of the older privacy settings.

To read more and stay current with news about Facebook changes, an excellent resource is the Electronic Frontier Foundation’s blog. EFF is a non-profit organization which is devoted to protecting your digital rights. You can find links to many of their updates in the reference section.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

Bankston, K., Facebook Privacy Changes Inspire Praise, Optimism, and Skepticism. June 1, 2010. Retrieved June 5, 2010 from http://www.eff.org/deeplinks/2010/05/facebook-privacy-changes-inspire-praise-optimism

Behnke, Stephen, Ethics in the age of the Internet. APA Monitor on Psychology, July/August 2008, 74-75.

Lee, Jessica, The Inside Facebook Guide to Protecting Your Privacy on Facebook, May 13, 2009. Retrieved June 5, 2009 from http://www.insidefacebook.com/2009/05/13/facebook-privacy-guide/

O’Neill, N., Ten Privacy Settings Every Facebook User Should Know. February 2, 2009. Retrieved June 5, 2009 from http://www.allfacebook.com/2009/02/facebook-privacy/

Opsahl, K., Updated: Facebook Further Reduces Your Control Over Personal Information. April 19, 2010. Retrieved June 5, 2010 from http://www.eff.org/deeplinks/2010/04/facebook-further-reduces-control-over-personal-information

Opsahl, K., How to Opt-Out of Facebook’s Instant Personalization. April 22, 2010. Retrieved June 5, 2010 from https://www.eff.org/deeplinks/2010/04/how-opt-out-facebook-s-instant-personalization

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Opsahl, K., Six Things You Need to Know About Facebook Connections. May 4, 2010. Retrieved June 5, 2010 from http://www.eff.org/deeplinks/2010/05/things-you-need-know-about-facebook

Opsahl, K. How to Get More Privacy From Facebook’s New Privacy Controls. May 26, 2010. Retrieved June 5, 2010 from http://www.eff.org/deeplinks/2010/05/more-privacy-facebook-new-privacy-controls

Recupero, Patricia R., Legal Concerns for Psychiatrists Who Maintain Websites. Psychiatric Services, April 2006, Vol. 57. No. 4, 450-452.

Zur, O., Williams, Martin H., Lehavot, K., and Knapp, S. Psychotherapist Self-Disclosure and Transparency in the Internet Age. Professional Psychology: Research and Practice, February 2009, Vol. 40. No. 1, 22-30.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) Managing Facebook as a mental health professional. Retrieved month/day/year from http://drkkolmes.com/2009/06/08/managing-facebook-as-a-mental-health-professional/.

Managing Twitter As a Mental Health Professional

Social networking is great. It can be fantastic for our clients in terms of finding support and connection. It can also be wonderful for those of us who want to market ourselves or network with other professionals. It can even be good for us in the same ways it is for our clients: connecting us with friends or family members, and helping us to find our own support. However, there are also risks related to social networking for mental health professionals, and it is wise to carefully consider how you want to utilize social networks before plunging right in.

Professional vs. Personal

Any mental health professional considering joining a social networking site should first consider each network you wish to join and then develop clear goals, as to how you think you’d like to use them. One of the biggest risks of social networking for therapists is getting into sticky situations expressly discouraged by our ethics codes (i.e.– dual relationships, confidentiality breaches, and other boundary issues) when you do not clearly define for yourself whether you are using a social network as personal or business space.

So your first step when creating an account on a site like Twitter is to consider whether this space will be a place for you to market your business, or a place for you to interact with your friends. If you want to have both (and I believe we all deserve to have both!) I am a strong advocate for making two separate accounts for the two different purposes. If you are going to do this, be sure to use separate email accounts for the separate accounts you create on each network to minimize the possibility of work contacts and clients finding your private account and vice-versa.

Developing a Professional Presence

So now that you’ve opted to create a professional Twitter account, how do you manage it? When I am logged into Twitter as drkkolmes, I consider all of my actions and interactions to be part of my professional role as a psychologist. My professional Twitter account, like my professional blog, is an extension of my business identity. I am aware that I can be Googled by potential clients, current clients, past clients, employers, family members, or old school friends. I take great responsibility for what I post and consider it to be a part of branding myself as a serious professional.

To be blunt, I don’t use my professional Twitter account to post whether I’ve eaten a delicious sandwich, have walked my dog, or am off to meet a friend for tea. These are fine things to Tweet about, and, trust me, nobody loves raving about her food more than I do. But it is my opinion that these Tweets are more appropriate for a personal Twitterstream than a professional one. I recommend that you not use your professional stream to broadcast what you’re doing, when, or with whom. If you do wish to create a private Twitter account to share these kinds of personal tidbits, I recommend using a non-professional email address and locking your account so that it is friends-only.

Friending and Following

Some people believe that you should follow back anyone who starts following your Twitterstream. But when I am on a social networking site with my professional hat on, I am selective about who I friend and follow. On Twitter, I do not follow clients, and I do not follow friends. If you want see what you’re friends are up to, or you want to post personal updates, then by all means, create a private, personal Twitter account.

Why do I feel you shouldn’t follow clients? For a few reasons. First, it can easily compromise confidentiality by making visible a professional relationship. Second, it may invite clients to interact with you on Twitter in a non-secure medium (people you follow can direct message you on Twitter’s less-than-secure platform). If this were to happen, it brings into question whether or not these interactions become a legal part of the client’s records. Third, it brings into question clinical issues related to whether you are expected to pay attention to their updates and discuss these Tweets in treatment (and what if they Tweet that they are feeling suicidal?). Fourth, I want to use Twitter to receive professional updates about the field of psychology–not to get information about my client’s lives, which I prefer to hear about in-session.

This is also a good time to mention that I actively discourage clients from following me on Twitter. If I happen to recognize that a client has followed me, I wait and bring it up in-session. I talk a bit about my concerns about their privacy and I will suggest that they subscribe to my RSS feed rather than following me. It’s not that I don’t want a client to see my Tweets. It’s that I want them to be aware that having an online link to me could potentially lead to someone guessing that might be my therapy client. Some may decide this feels okay and continue to follow me anyway, but I think that at the very least, it’s worth a conversation. This conversation also allows for us to acknowledge the impact that it can have on the therapy relationship when it moves out of the room and into cyberspace. It also opens the space up for us to return to this, in the future, if needed.

Who will I follow on Twitter? Mainly other mental health professionals. But not just any mental health professional and not just anyone who follows me. You, of course, need to decide who provides valuable information to you. What I am looking for on Twitter is to engage in professional conversations, to obtain mental health news, and to connect with others who are thinking–and posting–seriously about mental health concerns as they relate to technology and social networking.

Sometimes, I may start following another therapist on Twitter, but if I discover that she’s mostly posting about her own personal emotional struggles or what song she’s listening to on the radio, I usually will stop following her pretty quickly. This may seem cold, especially for folks who are used to negotiating and communicating about relationships. But again, it comes down to weeding out the information that’s not useful to you. If someone is not adding relevant news or information related to what you are looking for on Twitter, you don’t have to feel apologetic for un-following them. There are plenty of followers to go around!

Once you’re following more than 30 or so folks on Twitter, that can be a lot of information to scan through, and it can be easy to miss the information that is most meaningful to you. Your mileage may vary, of course, but make sure you are following people who post information that is useful and interesting to you as a professional. And, feel free to re-evaluate and modify your Follow list over time. This is also where Twitter lists can become useful. You can organize people you want to follow into lists and this can help manage the stream. There are also a number of Twitter apps (or tools) that can help you manage and track the people you follow.

Some Clinical Cautions

Of course, it goes without saying that whether you keep a public or private account, mental health professionals should avoid Tweeting about any clinical material that comes up in therapy sessions. Even if you mask identifying data, avoid names, or generalize, it can feel incredibly exposing to a client to come across a Tweet about something that happened with them in your office. It is also easy to assume that those who follow you do not know your clients, but that’s a dangerous (and oftentimes erroneous) assumption.  Just don’t do it. Your clients will be happier and you will be protecting your practice.

Also be aware that even if you only Tweet about professional issues and news, some clients may experience it as very un-containing simply to see you existing outside of the therapy room in online space. It can be irrelevant to some clients, but others may find it discomforting and you should be prepared to engage in conversations about it. In addition, be mindful that even if you are only Tweeting professional updates, you are still revealing information about your habits, your schedule, and when you are awake at night by what and when you Tweet. If you do choose to use Twitter to also post personal Tweets, again, be aware of how this could impact your current clients.

It is also good to be aware that you are not only making yourself visible to your actual clients, but to other people in their lives who may know they are in treatment with you. This could be friends, partners, and family members. So be aware that you are choosing to make yourself visible in the world in a way that may potentially have an effect on your clients’ relationships and the perceptions of others in their lives about you and your practice.

If you have emailed at any point with your clients with the email address you use to create your Twitter account, you should be aware that you may come up in your client’s search when they look for “friends,” on the Twitter site, and vice-versa. It is very easy to accidentally, with a click of a button, auto-follow everyone in your address book. So be careful of this and also recognize that a client may follow you accidentally through this feature, and vice-versa.

Twitter Faux-Pas

How can you muck up your professional Twitter profile? Don’t interact with others or respond to questions. One of the lovely things about Twitter is that you can interact with many people. If someone posts a question that draws you in or is relevant to the work, by all means, reply. One of the things I most love about Twitter is that you can still participate in conversations with folks on Twitter, even if you are not formally following them. I peek at lots of posts and conversations Tweeted by people I’m not regularly following. I also review my own @replies often and can see if someone has asked me a direct question. I can easily @reply back without having to follow the person if they do not regularly post updates of interest to me.

Another thing you can do wrong on Twitter is post questions and then fail to acknowledge those who responded to them. If you are putting out questions to the Twitterverse, by all means let folks know you have seen and appreciate their responses. Otherwise, it can feel very one-sided and people may stop responding to your questions since you don’t seem really engaged in a real exchange. In that same vein, be careful of only using Twitter to promote yourself. I’ve seen some people whose only Twitter posts are their blog updates or news about their businesses. Even worse, is making your Twitterstream consist solely of automated blog feeds. This becomes tedious very quickly. Anyone can RSS to your blog feed if they are interested, but if you are using Twitter, then make it interactive. Rave about someone else’s site or link to useful information that others have provided. Share and promote others. It will come back to you.

Time to Tweet

If you’ve been itching to get onto Twitter, go for it. Post some questions, link to some articles, and if you have a website or blog, let folks know when you update it. If you see someone posting something that you like, Retweet it (you do this by posting RT @theperson’s name and add the link they posted). Of course, feel free to join and just observe for awhile. It’s okay to follow people and think for a bit about what you’d like to say. Nobody’s going anywhere.

So now it’s time to Tweet! Be cautious, but have fun, and start connecting. There is a lot of good information to find and share, and there are a lot of potential relationships to build.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) Managing Twitter as a mental health professional. Retrieved month/day/year from http://drkkolmes.com/2009/05/04/managing-twitter-as-a-mental-health-professional/.