Another change that will affect everyone is the change to Pages. On people’s profiles, the Pages section will now be folded into Interests and users will be asked to convert Pages into Interests.

To quote from the CNN article linked to above:

So what happens when you are asked to convert your Pages into Interests? Let’s take a look.

When I logged into my Facebook account last night, I was informed that they had “improved” the profile so that it links to Pages, and I was offered the opportunity to convert my Pages. I wasn’t given a No option. Simply Link All to My Profile or Ask Me Later.

You can click on all images below to view larger versions.

You’ll note that in the image, there is small print saying, Learn more. When I clicked on Learn More here is what I learned: I learned that this was a really great thing that was going to enhance my Facebook experience and make my life an overall happier place.

There was no clear or accessible information to learn more about a decision NOT to convert Pages or how to not have them show up or even how it might compromise my privacy to just go ahead and Convert All as I was being encouraged to do.

In order to remove the Pages, I had to go at it sideways. I went back to my profile and selected Edit Information when viewing my profile.

Here is where I was able to select or deselect the Pages and confirm whether I did, in fact, want them on my profile.

Since the privacy updates will now make you connected to others via a number of your interests, I unchecked the boxes next to these Pages, and was subsequently warned that this would create blank spots on my profile. Okay with me.

Back on my main profile page, I was given a message to explain why some of my information had disappeared.

It is disturbing that never once in the process was I given any information about how the changes would affect my privacy. There was no link to a privacy policy or statement about what this step would do. There was just subtle pressure to go ahead and make the changes and warnings that I was going to make myself a Facebook pariah by not having certain information on my profile.

So where is this information to be found?

If you click on Help Center under your account on the right side of the screen, you will be taken to the Help pages.

In the Help Center, on the far right, there is a statement about New Profile Connections and a link to where you can Learn more about the new Community Pages and profile connections.

When you click on that link to learn more, here is where all the information I should have received upon login was hiding:

And of course, you can click on each topic to expand it, and there is the information about how this will affect the content on your profile.

Lots of people use Facebook. But not everyone is tech-savvy. There are moms and dads on Facebook, young people who are not tech-smart, teachers, doctors, and just plain old people who care about their privacy now and then. Even folks who are tech-savvy shouldn’t have to hunt around for updated privacy information.

So come on, Facebook. When you make changes that influence privacy, the very first pop-up we see when we sign into your site shouldn’t be a link asking us to Convert our Pages to Interests. It should be a link to how the action you’re asking us to respond to right now is going to affect our privacy.

Some further changes to Facebook?

There’s a Wall posting that’s been forwarded by folks saying:

FACEBOOK is at it again…violating your personal information: As of today, there is a new privacy setting called “Instant Personalization” that shares data with non-facebook websites and it is automatically set to “Allow.” Go to Account > Privacy Settings > Applications and Websites and uncheck “Allow,” then confirm that you’re opting out. Please repost.

I followed this path, and sure enough, here is what I saw:

When I clicked on “Allow” to deselect it, here’s the message I saw:

More information about how I may be depriving myself of a “richer” Facebook experience and the disclaimer that even opting out will not prevent my friends from sharing this information with others. Again, how come I had to be notified about this by my friends, Facebook, and not the service itself? Shady.

If you’re a mental health professional trying to keep a low profile on Facebook, you might consider emptying your profile of information you don’t want to share with people you are not directly connected to. Or, you may wish to also remove Pages/Interests from your profile to reduce the likelihood of being connected to others. A new option is becoming available which allows you to hide this information on your actual profile–again something I discovered through active searching but not made clear to me at any point during login.

A number of folks are talking about committing Facebook suicide. As we enter a new world in which our privacy is compromised without our notification, I can see the appeal.

Update, April 23

Kurt Opsahl at the Electronic Frontier Foundation also offers some detailed information on How to Opt Out of Facebook’s Instant Personalization.

One last note from me. A lot of folks recommend that you choose “Only Friends,” for many of your privacy settings. As I say to my colleagues, when it comes to Social Media, I am equal mixes of conservative, paranoid, yet adventurous. The paranoid part of me would like to recommend that you click on “Custom” for many of these settings and choose “Only Me,” for many of these settings if you really want to limit what folks can see on your profile. Why not? If they are really your friends, they know this stuff about you anyway, right?

I will be facilitating a Singles Salon for bisexual and lesbian women in San Francisco with HersnHers Connexions and Betty’s List in the coming months. Read more for details:

Talking About Dating, Relationships, Sex and Romance

A Salon Series from Hers & Hers Connexions

Dr. Keely Kolmes, Facilitator

When

Sunday Afternoons, 4:00 PM – 6:00 PM
May 16th, June 20th, July 11th, and August 22nd

Where

Castro Neighborhood Location in San Francisco

Topics

- Flirting & Making Connexions
- First Dates
- Managing Multiples & Monogamy / Sex & Singlehood
- Dating Deal-breakers, Deal-sealers, and Matches That Make It

Registration Information & Cost

$40 Per Session – Registration Required
Call the “Betty’s List” office line 415-503-1375 to schedule one or more sessions. Each is limited in size.

Salon participants will meet once-per-month for a free-flowing facilitated conversation on being Single that provides the chance to talk, listen, learn and explore a key life experience. Single life comes easily for some but is a challenge for others.

Come share your dating experiences, learn and be supported in your journey. Sessions begin with informal mingling, followed by the facilitated discussion.

Option to bring food or beverage to share.

**Please note that this is not a psychotherapy, support, or counseling group.**

I thought I would share with my blog readers my Five Dating Tips for Singles that I shared at the event last weekend:

1. Know yourself

Dating can often feel like one part clarity to two parts confusion. Learning more about your wants and needs can help turn that ratio around. Spend some time allowing yourself to dream and let go of previously held assumptions or the pictures other people have painted for you of what is ideal.

Do you want to date women, men, transfolk, any-or-all, or just whomever makes you feel happiest? Do you enjoy dating? Or would you prefer to focus on finding a serious relationship? Is dating even what you want to do right now? Don’t assume you should date just because you are single.

Do you like being monogamous or are you open to having multiple partners or romances? Are you seeking a traditional relationship or are you open to something less “standard,” such as living separately?

Allow yourself to think of what has worked for you in the past and what hasn’t worked so much. This will help you develop a clear picture of what you want now, and when that picture gets clear, it will be easier to communicate that vision to others who may want to be in it. You may be surprised to find that if you take some space and really think about it, the script you’ve followed before may not be the right dating script for you today.

2. Evaluate whether you are creating space for what you want

Getting clear on who you are and what you want is one thing. It’s another thing to take an honest look at whether you are allowing room in your life to find what you want. This can be a good thing to check in with your friends about. Are there things that keep you from connecting to others?

Some things that came up in my talk last week that can frequently get in the way of dating included kids, work, hobbies, exes or other relationships, and other passions which take up time and space. All of these things are good, but is there balance? You may want to see if you need to clear out some space to allow a new sexual intimacy or romance to bloom in your life. Re-evaluate periodically to be sure you’re dividing up your time the way you like. This could even mean noticing that you’re spending more time and energy on dates than you want to be, and you may need to adjust so that it feels more like pleasure than a mission.

3. Learn to understand your dating plan or style

Some people love using personal ads to meet people. Others prefer getting out to events and organized activities in order to meet new folks. Some people like physical activities like sports, dancing, or excursions while others like events focused on talking and conversation. Others may like just getting out in the world in less organized ways or going to bars or clubs. These preferences can depend a lot on such attributes such as shyness, introversion, or extraversion.

Think about how you have met friends and dates in the past. Now may be a time to shake up your routine and try something new or to fully embrace your style and recognize your preferences. Think about how you like to plan dates: do you prefer to take the lead or do you like another person to suggest activities or surprise you? Do you like to stay in your comfort zone on first dates or do something new to you?

This is also a good time to figure out how many dates a week you have the stamina for. One? Two? More? With how many different people? Do you need to make a decision about the potential of a new person quickly or does it take time for you to figure out if something can be more than a friendship? Are you comfortable with your pace and can you allow yourself to respect it? These are all important things to know about yourself before venturing into the dating waters.

4. Get clarity on what you can and can’t live without

Sit down and think about which qualities matter to you most in a date or a life partner. Make a list of things that you know you can’t do without. Make a similar list of things that are deal-breakers that would send you running in the other direction. There may also be things that you are more flexible about. What are they?

In your first drafts of these lists, allow yourself to be impulsive. You can re-evaluate later and some yes or no items may later move to the maybe zone. Think about whether chemistry or emotion ever leads you to ignore what you know you need or want. This may be a good question to ask some of your closest friends about too. They may have observations about your dating choices or style that are useful to hear. Friends can also help you keep your head and think about whether you discount people for superficial (or more “maybe” reasons) when they have a lot of the qualities on your “must have” list.

5. Check your responses

Are you finding that you are responding strongly to rejection or missed connections? Do you get disappointed often in dating? Are you having any fun? If you find that you are frequently in conflict with others on dates or that it feels like work or a bad time overall, it may be time to put things on pause and take more time to reflect on what’s blocking you. Remember that primal issues and emotions and even past traumas can get strongly tapped in in dating and relationships. If this seems to be a theme, you may want to consider therapy to help clarify what is in your way and help you get on track.

And remember that new relationships can also benefit from therapy! People do not need to wait until a relationship is in trouble to learn to develop healthy ways of communicating and handling conflict. New couples sometimes go to therapy to learn how to plant the seeds for a more fulfilling relationship. So if you find someone in your dating adventures who is worth hanging onto, be open to putting some work into the relationship in the beginning. I will offer Tips for New Couples in a future blog post!

I will give my Dating Tips for Singles and will facilitate small group activities that will help folks relax and easily get to know one another.

This event is for single women of all ages and my interactive part of the evening will be followed by dancing with lesbian rock band Finding Stella.

Please join us!

Saturday, February 6th
5:30 PM – 11:00 PM

Find out more and buy your tickets now, on Betty’s website.

The program includes:

- Single Exchange Sessions – Mingle & Interactive: 6:00 PM – 8:30 PM

- Break & Reset: 8:30 PM – 9:00 PM

Hotel Adagio
16th Floor Roof * Siena & Seville Rooms
550 Geary Street (between Taylor & Jones)
San Francisco

You can also look forward to the spring when Betty and I will be putting together an exciting series of Singles Salons for queer women.

More details to come!

The rest of the issue includes articles about online self-assessment on Google, blogger support communities, online therapy, and an analysis of treatment for Internet addiction. The issue also includes a Q&A on ethical, legal, and licensing issues in clinical work online, and a brief introduction to “the Net generation,” for clinicians unfamiliar with online life. So be sure to check it out if you are interested in clinical issues and digital life!

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/.

But one doesn’t have to be a mental health professional or a client to be affected by the changes made by Facebook. We all deserve personal privacy and I feel that the ways in which profiles have become more visible have not been adequately addressed in Facebook’s statements to users.

Here is Facebook’s updated privacy statement from their Help page:

Some settings are changing with the recent updates to Facebook privacy, but Facebook’s commitment to providing you control over your information is not. Here’s a summary of what’s changing:

* The Privacy page has been simplified, and in that process, some settings have been consolidated. For security reasons, you will now be required to enter your password if you’d like to update your privacy settings.

* A privacy control has been added to the publisher at the top of your home and profile page. This allows you to set privacy on individual posts. For example, you could post a status to Everyone or only to Friends. Learn more on the Publisher help page.

* Instead of having networks for regions (eg., Australia or New York City), people’s locations are now listed in the “Current City” or “Current Region” field of their profiles. This means if you use the “Friends and Networks” privacy setting, the networks part only applies to work and school networks.

* A basic set of information is publicly available, meaning it’s visible to anyone that’s able to navigate to your profile, applications you use on Facebook, and websites you connect with via Facebook. This information includes your name, profile picture, gender, current city, networks, friend list, and Pages. Any additional information (eg., photos or videos) will only be exposed if your privacy settings allow it.

Keep in mind that anyone who navigates to your profile will be able to view your publicly available information and information you’ve made visible to Everyone. In addition, your profile picture appears in places you make comments and posts. You can always change your current profile picture or lower your search visibility if you choose.

Here are some of the changes that are particularly unsettling to me as a mental health professional who works with many people who had opted for great profile invisibility in the previous version of Facebook:

No more hiding your email from email searches

Previously, you could opt-out of email searches so that you (or your patients) could choose not to have every person they’d ever contacted via email be able to find their Facebook profile. Now, there is no longer an option of hiding yourself from email searches. This means that Facebook gives you the illusion of invisibility by giving you the choice of omitting yourself from a general Facebook search (which you do by going to Privacy > Search and limiting your profile to be seen by “Only Friends,” and disallowing Indexing from search engines. Nevertheless, hundreds of people can still find your profile, depending upon the number of people with whom you have exchanged email using the email address that is linked to your Facebook account.

Why is this disturbing? First, it’s simply misleading since many users will assume that their profile is hidden due to tweaking their Search settings. Second, by making it impossible for you to hide yourself from email searches, your Facebook profile will show up to anyone who uses “Find Friends,” in the email search to find users in their address book. That means your profile is really visible to more than “Friends Only.” While many Facebook users like to be found by random (and not-so-random) people, there are many of users who would prefer that their profiles would not be visible to others, including health care providers they’ve exchanged email with, clients they work with in a professional setting, co-workers, exes, or people who have stalked, harassed, or abused them in some fashion in the past. Users no longer have the choice to choose true privacy.

As an experiment, I tried what seemed to be a simple work-around to this: changing the email address that is associated with one’s Facebook account. But after creating a new email address for my Facebook profile and removing the old email address associated with my account, my profile and original email account still come up in other users’ “Find Friends” email searches. It is unclear to me whether this will update over time. However, changes in privacy settings on Facebook usually update immediately, so it’s of some concern that this is not updating after I’ve removed an email address from my account.

Friends lists unveiled

“All friends,” are now visible on all user profiles, once you’ve navigated to the profile. As a psychologist, and semi-private person, hiding my own friends list was a feature that I particularly liked on Facebook. It allowed me to participate in online culture while still enjoying having a (semi) private personal life. Friends of mine could always see if we had friends in common, but I employed settings that allowed me to keep my total list of friends for my eyes only if we did not share friends. I felt that allowing all people in my life a list of all my friends was more information than I wanted to share and I liked having that choice.

This choice is also gone now. I find it especially troubling now to think that there is no way to keep curious strangers, professional contacts, or previous acquaintances from clicking on a user profile and seeing who all their friends are. Many people may not care about hiding this information, but to remove the option for people to select a privacy level is problematic. It also allows any user to navigate to another users profile if the person knows which friends of theirs to target in a search. Again, I see this as having potential safety implications for people.

Profile Photos and Comments Are Now Visible

With the new settings, if you default to your previous privacy settings it gives you the impression that others cannot view your photo and the rest of your profile. Not exactly true. This actually entails additional steps in which you must go to your Profile Photo Album and reconfigure the settings for that album.

Previously, you could make it so that your photo showed up as a generic figure when another user viewed your wall posting and someone who was not your friend could not access any part of your profile.

No more.

Now, your Profile Photo shows up anywhere you post anything and any user can click on that photo or icon or name to view your basic profile. Furthermore, that user can then click on your Profile Photo and see all of your profile photos, including any comments made on them by other users. You can hide this, but this setting has to be adjusted separately and many users will remain unaware that a big piece of their personal information can be viewed by others.

In the name of beta testing, I tried this by clicking on the profile of an old college friend who had previously denied my friend request because….well, I’m not sure exactly. But let’s just assume that this user has stricter friending criteria than I do. In the past, this person’s profile just showed me a generic illustration for her photo. But when I clicked on that illustration today, I was able to view six profile photos, including her family photos and other people’s comments on them.

This is a huge breach of privacy for many people who thought they were hiding this information from others.

Facebook is giving people the illusion that they are making their profile more private, when an unlimited number of people now have greater access to user profiles. Some users will not be savvy enough to even recognize how much more information is visible to others who they do not want to have access to this information.

That’s just wrong.

Update: December 11, 2009

Seems that Facebook has responded to user outrage and added back the ability to hide “All Friends” on profiles.

Recently, I was having one of those weeks. The details aren’t important, but I’ll acknowledge that I had taken on a few too many things. Top it off with having a few people needing to meet at different times. Add to that one way I manage client confidentiality: putting client names into my hard calendar (which I do not carry about with me) and then transcribing the sessions later to my iPhone calender simply as “client,” to preserve confidentiality in the event that my phone is lost or stolen.

The result?

I mistakenly transposed a client session time from my hard calendar to an hour later in my phone. And, yes, I missed the client appointment. A client arrived at my office, waited in the waiting room, perhaps knocked on my door, wondering about my whereabouts, and I wasn’t there. The mistake was realized within the hour and I phoned her and we spoke.

But still. I was confused and felt bad that it had happened.

After eleven years of becoming accustomed to some clients not showing up, some clients canceling last minute…this was new. Never before had I been the one to miss the session.

Therapy is about being present. Being witness to your client’s emotional life, and literally, being awake and engaged for fifty minutes at a time, taking in all that your client shares and responding based upon your knowledge of the history of this person. What then, do you do when you fail to be present in the most obvious of ways? By actually not showing up?

This event brought me back to 1992:

A year into therapy with my therapist, I show up at her office, which also happens to be her home. As I pull my car into her long gravel driveway, deep into the woods of Pittsboro, NC, I notice that her car isn’t there. Hmm.

Maybe her car is being serviced?

The front door of her home is unlocked, as usual and I open the door and let myself into her office and sit down on her couch to wait. Her orange tabby cat pokes his nose into the office and then rubs his body against the doorframe as he sways back into the recesses of the house.

I wait for about ten minutes, but I think I knew she wasn’t there from the instant I’d arrived. Still, it slowly dawns on me that she’s not just running late…but she probably isn’t coming to our session at all. This is….different.

I stand and walk into the hallway and hover there, weighing the threshold between her therapy office and the rest of her home..the edge where her work life ends and her real life begins. I look for the first time into her living room…forbidden territory which I’ve never had a real glimpse of before. I scan the room, taking in all I can from my vantage point in the doorway, looking at signs of her lived life: a blanket on the sofa, books and magazines on the table, pictures on the walls, a coffee cup on a side table. I call out her name. Nothing. Nobody home. I note the desire to walk further into her home and poke around. This seems such a unique opportunity to learn more about her, but the thought of being discovered wandering around her home is a strong deterrent. I slowly leave her house, get back into my car, and drive home.

When I get home, I call and leave a message: “It’s Keely. I think you forgot our appointment today.” She calls back later that day to apologize and I joke on the phone,”Well, I was going to discuss my abandonment issues with you today, but you didn’t show up.” I appreciate how it feels completely okay for me to make this joke because she has been there for me, week after week, for over a year. It is clearly a joke, and her missed appointment this day is a clear aberration. I know she will laugh at my joke. And she does. And that feels good. I know she knows it’s not a big deal to me, and that she is forgiven.

I can’t even remember if we spent any more time of it other than a brief acknowledgment at the beginning of the next session.

Back to 2009:

But here I am, 17 years later, a therapist myself, who is earlier into treatment with some clients who do not yet know or trust that I will be there for them. When we make mistakes as therapists, how do we convey both our regret, and the reassurance that this is not typical. And, more importantly, despite the fact that (hopefully) mistakes of this nature are atypical how do we position ourselves to be fully available for the range of our client’s feelings, whether they be rage, despair, sadness, or blame over the fact that we have let them down? Some clients may shrug off a mistake as no big deal, but for others it can be a very big deal. We cannot let our own desires for forgiveness and understanding get in the way of our first job to our clients which is to be present for their feelings.

Many of our clients have long histories that involve being let down by others. When a therapist fails the client in any way, this often ripples on the theme of being let down by others. It can be important to show up and be present for the processing of how this affects our client. Patients can also use their own responses to therapist errors to explore past failures by others in their own lives. When a therapist hides or denies her mistake, she not only risks avoiding an opportunity to move the therapy forward, but also creates a second breach by showing she cannot be trusted to model appropriate responsibility or, even, the ability to enact human error.

This brings me to my other point: the awareness that for some of my clients, a big piece of the work is about perfectionism and self-forgiveness. How do we allow ourselves, as therapists, to be both present for our clients, and, at the same time, models of real human beings who are imperfect? Is my self-flagellation a lesson I want to share with my client? Or would it better benefit her for me to be self-forgiving? Where does one find the balance, and how much of this can we convey to our client? How do we create appropriate space to talk about mistakes without spending too much time on them? Do we make it clear that the client can return to it, if we move on and she later finds it’s still nagging at her? Difficult questions and likely the right response depends upon each particular client.

Another factor for consideration: my office policy explains that I charge my full fee if a client does not adhere to my 24-hour cancellation policy. I do not feel it bodes well for the therapeutic relationships if we convey the belief that we value our own time more highly than those of our clients. This can be an interesting conversation to have with a client. What would she think is fair in the event of a therapist missing the session? A free session? A half-fee session? An extra fifteen minutes at the end of one session? A free pass for a same-day cancellation in the future without the penalty of full-fee? What is appropriate for a therapist to offer and what veers again into the zone of being too repentant? This exchange can be a rich opportunity for exploration with clients who wish to engage in it. Again, this can also bring up deeper issues related to fairness and resolution connected to other issues in our client’s lives.

In the end, an important lesson for me as a therapist was that sometimes unintended things happen. We may strive for consistency and perfection, but we are all imperfect. We hope that over time that our consistency and responsibility will become apparent to our clients. But one goal of therapy is to reach a safe attachment in which one can weather disappointments and unintentional blunders without either party (especially the client) having to experience the threat of losing the relationship. Mistakes do happen and sometimes it’s just as important for us as therapists to remember this as it is for our clients. And, as in all relationships ― not just the therapeutic ones ― it’s often not about whether mistakes occur, but how they are acknowledged and repaired that really counts.

What is a Multiple Role?

A dual or multiple role is when a therapist is in a professional role with a client (or student/supervisee) while simultaneously in another role with that individual (or someone closely associated or related to that person).  It can also be if a therapist is in a professional role with a person and promises to enter into another relationship in the future with that person or someone closely related to the individual. Dual roles refer to two different roles and multiple roles are when more than two overlapping roles exist.

Some Examples of Multiple Roles

Dr. Jones has a close friend, Andrea, who talks a lot about issues with her husband, Mike, and their intimacy problems. Over time, the Andrea convinces Mike to seek therapy. Andrea asks Dr. Jones for referrals and the Dr. Jones says that finding a therapist can be difficult so she would be happy to save Andrea and Mike the trouble and she will be happy to treat Mike herself.

Dr. Smith is seeing a patient, Jim, for whom she feels a strong sexual attraction. Several months into treatment, she tells Jim that she is looking forward to the end of therapy because then they can become friends and possibly even lovers.

Dr. Nelson is seeing a patient who is an art dealer. During the course of treatment, the client talks about a piece she wants to sell by Dr. Nelson’s favorite artist. The next sessions focus more on the particular painting and during the therapy, Dr. Nelson arranges a deal through her patient to buy the artist’s work.

Why Are Multiple Roles Avoided?

The short version is this: the purpose of avoiding multiple roles is to avoid conflicts of interest in our work and to avoid exploiting or otherwise taking advantage of the power we may have over the people with whom we work.

What Does the APA Ethics Code Say About It?

Regarding multiple roles, The APA Ethics Code Standard 3.05 states that psychologists should refrain from entering into multiple relationships if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

The APA Ethics Code explicitly addresses some types of multiple roles, including prohibiting sexual intimacies with current therapy clients/patients in Standard 10.05, prohibiting sexual intimacies with relatives or significant others of current therapy clients/patients in Standard 10.06, and prohibiting therapy with former sexual partners in Standard 10.07. Regarding sexual intimacies with former patients, Standard 10.08 outlines the extremely rare circumstances in which it may be permissible for such a relationship to develop. It should be noted that the mere suggestion of a possible future sexual relationship during the course of treatment is in and of itself an ethical violation and would invalidate the legitimacy of such a union.

Bartering is a particular kind of multiple role which can come up with clients. The Ethics Code states in Standard 6.05 that the acceptance of goods, services, or other non monetary reimbursement from clients can be done only if it’s not clinically contraindicated and if it is not exploitative. The challenge here is that it’s not always easy to know at the outset if a bartering arrangement will be smooth or complicated. If one party decides down the line that they have a different opinion about the exchange value of the services provided, this arrangement could quickly go south. Lastly, Standard 3.06 outlines that therapist refrain from taking on professional roles when there are conflicts of interest including personal, scientific, professional, legal, financial, or other interests which could impair objectivity, competence, or effectiveness in the therapist’s primary function as a psychologist.

What Are Some Examples of Multiple Roles That Could Impair Therapist Objectivity or Exploit Clients?

Let’s use the example of Dr. Jones who has decided to see her pal Andrea’s husband, Mike, in therapy. Suppose that after Mike and Dr. Jones meet for several sessions, Andrea mentions at lunch with Dr. Jones that Mike has a chronic drug problem that she hopes he’s mentioned in therapy. Suppose Mike tells Dr. Jones that Andrea is physically abusing their child. Or, suppose Mike wants to bring up issues about his sexual relationship with Andrea in the therapy, but he feels he can’t share certain things with Dr. Jones because he fears negatively influencing his and her friendship with Andrea. This is an unfair burden for Mike to hold.

Clearly, in the above scenario, there are a number of role conflicts that could get complicated very quickly. This doesn’t even take into account the challenge of Dr. Jones having to hold confidential information that she hears from Mike that she cannot share with Andrea. While Dr. Jones may have very good boundaries around protecting confidential information, it can still be easy to slip up and forget who has shared what when she is hearing stories about the same events and relationship from two different people.

Here is a different scenario which provides an example of multiple roles leading to potential exploitation: Dr. Bloom meets with a new patient, Anthony, who wants to work on his social anxiety. After a few sessions, Dr. Bloom attends a dance class and discovers that Anthony attends the same class. They discuss this in the next therapy session and decide that it seems okay to continue both therapy and attending the same dance class. After a month, Anthony stops attending the dance class and starts coming late to sessions. He seems easily angered by the therapist. When Dr. Bloom tries to explore this with Anthony, he angrily accuses Dr. Bloom of using the dance class to monitor his progress on social anxiety issues and admits that his anxiety has worsened due to his feelings of being scrutinized by Dr. Bloom in public. Dr. Bloom may not have been aware of the effect his presence in the dance class was having on the Anthony, but it’s easy to see how the additional role overlap led Anthony to feel uncomfortable with the arrangement. It’s also easy to understand that given Anthony’s social anxiety, he may have found it difficult to assert himself and ask Dr. Bloom to consider attending another dance class.

The above examples illustrate how even with the best intentions, multiple roles can create an array of potential problems. Oftentimes, it is easier to avoid the potential conflicts rather than approaching the situations with over-confidence about one’s ability to manage the complexities.

What Does This Mean to Me (The Client)?

It’s not your job as a client to avoid dual roles or multiple relationships, although you certainly have a choice about whether to enter into a therapy relationship when you know a multiple relationship exists. One such example is when a close friend (or someone you’re dating) refers you to their therapist and you know that the issues you wish to discuss in treatment are related to your relationship with the person who referred you to therapy. This is a time in which it may be better to look for a therapist who is a bit more removed from the relationship. Ultimately, it’s the therapist’s job to assess potential dual role situations and to use her or his best judgment but it may be useful to you to better understand the reasoning behind why multiple roles can become complicated. And this may also help you to understand why some therapists make particular decisions to avoid such situations. Of course, not all multiple roles will be apparent to you or your therapist from the beginning.

Social Networking and Multiple Roles

Social networking is creating new opportunities for therapists and clients to encounter one another out-of-session, and one of the discoveries it may provide for both therapist and client is social overlap. You may uncover information via the internet that leads you to find you have friends (or other contacts) in common with your therapist. You may feel comfortable with this information as a client, or you may find that it makes you feel uncomfortable and makes you feel self-conscious knowing about connections that you’d have preferred not to know about. Many of these connections likely existed before, but new sites which list people’s contacts have made it easy to discover networks of friends which were once veiled. This can be magnified when you are a member of a minority group and are seeking a therapist who serves such minorities (or identifies as one). This can happen in ethnic, religious, disability, or sexual minority circles.

What if I Become Aware of Multiple Roles and I’m Not Sure my Therapist Knows?

Therapy is a place where you need to feel secure and comfortable. If you think your therapist has a significant relationship that may have an effect on your feelings of safety in therapy, then it is reasonable to bring this up with your therapist. Be aware that if the other person is an actual client of your therapist, your therapist will be unable to disclose or confirm this fact. But a competent therapist should be able to address your feelings around this and talk to you about it. In some situations, it can make sense to get a referral to another therapist, if the role conflict has could interfere with your therapy and your experience of safety as a client. It will also be your therapist’s job to accurately assess whether the multiple role could impair her or his judgment, and proceed accordingly, perhaps seeking consultation, if necessary.

Are There Times When It is Acceptable for a Therapist to Be in Multiple Roles?

The ethics code is explicit that sexual role conflicts are always unethical, but there are times when non-sexual multiple roles cannot be avoided or when they may not be harmful. Multiple relationships that cannot be expected to cause impairment, risk exploitation, or cause harm are not considered unethical. Different situations offer unique characteristics that need to be weighed on a case-by-case basis. For example, when practicing in small or rural communities in which it is difficult to find a therapist nearby, it may be more common to work with a therapist who you encounter in other social or professional settings. Similarly, if you are a member of a ethnic, cultural, or sexual minority group and you are seeking care from a therapist in that community, there may be some overlap of activities and social circles. Some therapists are comfortable accepting invitations to special occasions such as graduations, speeches, or sporting events, feeling that their presence can be incorporated into the therapy. A skilled therapist will be able to discuss with you the impact and meaning of the multiple roles on the therapy and your feelings about it, and he or she should also be able to discuss how you may interact in other settings when your paths cross.

Bear in mind that some therapists have different boundaries than others and this can also be influenced by their theoretical orientation or other cultural norms. While one therapist may be very conservative about not treating clients individually whom she has seen previously in couples treatment, others may feel more comfortable about mixing the treatment modalities. Some therapists have different boundaries when it comes to distinguishing when a client is no longer a client and this may allow for different types of social or professional relationships to develop at a later point in time. Others feel that once someone is a therapy client, they will always be a therapy client, since they may return at any point in the future to continue work begun with that therapist. Therapists who feel this way are unlikely to enter into other types of relationships with former clients, even if they stop therapy.

Conclusion and Further Reading

Hopefully this has helped to clarify what dual and multiple roles are and why therapists often make efforts to avoid them, as well as why some therapists may feel more comfortable entering into some types of dual roles. If you’re interested in reading more about multiple roles in the therapeutic relationship, Ken Pope offers some great resources on dual relationships, multiple relationships, and boundary decisions.

Pre-panel, Photo by Thomas Roche

I wanted to provide an update on my recent experience at SXSW Interactive. I didn’t get to go to every panel I’d wanted to attend, but I believe most people come home from SXSW feeling that way.

Therapy 2.0: Mental Health For Geeks which I co-presented with Thomas Roche, was well attended with somewhere between 50-60 people in the room. As the room filled up, I wondered whether a group of this size would really allow for  a conversation, but I was pleasantly surprised to experience people talking with one another and sharing ideas, as opposed to simply directing their comments back to Thomas and me. There was quite a bit of energy in the room as people talked about how they sometimes feel overwhelmed by information. Some mentioned issues with non-privacy while others talked about the illusion of intimacy that one gets with social networking sites. One person observed that the frequent interruptions of technology have changed her experience of what it means to be alone, which I found interesting. People talked about their own tips for keeping healthy which included hobbies, breaks, exercise, and techniques such as leaving their devices at home.

Since we were doing a Core Conversation, rather than a formal panel, I wanted to create some resource so that folks could obtain information, if they felt compelled to do so after talking about all of these issues. With that in mind, I created a Therapy 2.0 wiki where folks are welcome to find out more. Please feel free to check it out for information related to self-assessment, books, online tools, and how to find a therapist. We ended our Core Conversation with my list of five things you can do now to improve your mental health. These are also on the wiki, but I am also sharing them here.

In summary, I had a wonderful time presenting at SXSW this year and am looking forward to returning next year, regardless of whether I’m presenting or simply listening and learning from the other inspirational panelists and attendees who show up each year.

Five Things You Can Start Doing Now to Improve Your Mental Health

1. Weekly gratitude practice

Research shows that keeping a weekly gratitude journal has significant effects on increasing optimism and decreasing reported physical symptoms. But don’t overdo it. Lyubomirsky et al. (2005) found that those who practiced gratitude three times per week saw less benefit than those doing it once a week, suggesting that there may be a habituation effect and loss of gains if you do it more than once per week. Consider putting a reminder in your calendar to do this once a week.

2. Breathing exercises/Mindfulness practice

If you find yourself feeling stressed or anxious, doing a simple breathing exercise can help lower your blood pressure, lower your heart rate, and bring your attention away from distressing thoughts. It is easy to let future-focused or past-focused thoughts get in your way and this can increase depressed or anxious feelings. Be sure to breathe deeply into your lower abdomen, rather than taking shallow breaths just into your upper chest.

Breathing exercises are one component of mindfulness which is the practice of staying focused upon the present moment. There have been many studies showing the beneficial effects of mindfulness practice on depression, anxiety, sleep disorders, stress, chronic pain, and other ailments. When practicing mindfulness, sit in a comfortable place and start with the breathing. Then focus simply on being in your body. Notice your weight in the chair and the sounds you hear. If worrisome thoughts enter your mind, bring your focus back to your breath. Try to do this for 5 minutes a day and work up to 15 minutes.

You may also consider searching for podcasts that offer relaxation, breathing, and mindfulness exercises.

3. Connect with others

There is much data suggesting that social support and connection increases mental health and feelings of self-worth while simultaneously decreasing stress. Consider joining an activity group, taking a class, or even volunteering somewhere.

Have a lot of work to do? Try co-working or just go to a cafe to get your work done.

4. Exercise

There is significant data indicating that exercise relieves symptoms of depression and anxiety while also helping with insomnia. Consider combining exercise with connecting with others by joining a gym or a boot camp or organizing physical activities with friends.

5. Thought-tracking

If you’re struggling with anxiety or depression, tracking thoughts and moods can be helpful. Thought records are a cognitive-behavioral tool that can help you examine thoughts and beliefs and how they influence your mood. You may notice patterns and less useful beliefs that come up in your inner monologue with yourself. Identifying these thought patterns can be a first step in changing them.