• What are the obstacles currently preventing you from being able to receive or afford therapy?
• Why do you want to go to therapy and what issues are you facing or problems are you experiencing?
• How would you like to benefit from therapy and what are you hoping to achieve?

Top entries were going to be chosen and then the winners would be selected by having readers vote on the one most deserving of the prize of free therapy. While I appreciate that many people find it empowering to use Internet forums to write about the issues they struggle with, having such comments used as a way vie for the prize of “most worthy” of psychological care, as voted by readers, was objectionable in a number of ways.

A number of mental health professionals, including DeeAnna Merz Nagel and others who focus on clinical ethics,  posted comments expressing concern that this contest was exploitative of vulnerable populations and would violate many clinical ethics codes. The initial response from the website was to say that as a referral service, they were exempt from having to adhere to ethics codes. They also noted that names and emails were anonymous in the blog comments, offering participants a layer of protection.

Nevertheless, a couple more comments were posted by concerned practitioners, including myself, stating that we thought the contest was not offering appropriate protection to vulnerable people and that having readers vote on who was worthy of the grand prize was, at the very least, in poor taste.

After just a few days of commentary, Goodtherapy.org responded by removing the public comments (entries) from the blog and deciding not to allow users to vote on stories to pick the winner. Winners will now be selected by GoodTherapy.org.

I am grateful to those who spoke up and left comments expressing opposition to the format of the contest. But I especially wish to commend GoodTherapy.org for their thoughtfulness and care in reflecting upon the objections raised. They demonstrated sensitivity and flexibility in revising the competition so that it does not expose people who are in great need.

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

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

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

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

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

This year, I had the pleasure of meeting Dr. Susan Giurleo, Ph.D., who led a Core Conversation on Improving Mental Health Through Engaged Communities, and Pamela Rutledge, Ph.D., a media psychologist, who was on the panel Can the Internet Make Us Happy? (as an added perk, you can listen to the audio of this session on the link).

I had two complaints about the formatting of the programming (which I will frame in the form of wishes). First, I hope that future health track panels will not be segregated to a separate campus. This made it more difficult to cross-pollinate with attendees and dip into sessions from other disciplines without committing to a dash to a different venue. Second, I hope that we have larger rooms next year for the health track. I assume that there are many SXSW attendees who might be interested in checking out the health panels but running to different campuses made it somewhat prohibitive for some. It also seemed to assume we only wanted to meet amongst ourselves which may not be accurate.

My session was called Patients/Caregivers on Facebook: Establishing Boundaries Without Barriers. It was organized and moderated by Ed Bennett, Director of Web Strategy at University of Maryland Medical System. We had several fantastic panelists: Jen Dyer, MD, MPH from Ohio State University, Dana Lewis, Interactive Marketing Specialist, and Dan Goldman, who provides legal counsel at Mayo Clinic. I want to thank everyone who came out to see our session (at 9:30am on Daylight Savings Sunday, no less!) and who helped make it dynamic and engaging both in the room, and on twitter. I hope to see you all next year!

Susan Spaight posted a lovely summary of our presentation.

Dana also posted a great recap of the lively twitterfeed of our panel which I’ve embedded below. Please give it a moment to load.

Related posts about this year’s Health track at SXSW:

• Ed Bennett’s blog post about our session
• John Grohol’s summary of psychologists at SXSW this year
• Reed Smith’s post 3 Reasons SXSW Can Change Social Health
• #SXSWH, the SXSWi Health Tweet feed
• Pamela Rutledge’s wrap-up on Psychology Today
• Tracy DiMarino’s summary of our session on PR 20/20

I’m pleased to be one of the contributors to this course.

This 3 unit CE course presents four audio interviews by Barbara Alexander, LCSW, BCD with the following speakers:

• Curt Kearney, MA, LCPC – “My Patient Wants to ‘Friend’ Me”
• Keely Kolmes, Psy.D.  – “A Social Media Policy for Your Practice”
• Lisa Johnson, Ph.D. – “Social Media Enhances Clinical Work”
• Frederick Reamer, Ph.D. – “Standards for Using the Internet and Social Media”

There is currently a pre-order special: $35 until January 15, 2011.

After that, the price will go up to $55.

Currently, you must order this by phone: 800-835-9636.

For those who do not wish to take the CE but who still want to listen to the interview, I will upload my segment here in the near future.

Listen to a brief clip of this interview:

Our names are Keely Kolmes and Dan Taube and we are licensed psychologists who would like to request your participation in our research on the effects of encountering your past or current therapist’s information on the Internet. This study has been approved by the Institutional Review Board of Alliant International University.

As a participant, you will be asked to complete an online survey covering your basic demographic information and your experiences regarding seeking or accidentally discovering information about your therapist on the Internet. We expect the survey to take about 20 to 35 minutes to complete.

Your input may help therapists to better understand if and how this information affects clients.

No names or personal information will be linked to the study and your participation will be completely anonymous so long as you do not put your name in your responses. If you should wish to contact the researchers directly, your participation may become confidential rather than anonymous, although your name will not be linked to any of the data you submit.

To be eligible for the study, you must be 18 or older, currently in psychotherapy, or have been in psychotherapy in the past, and have encountered or sought information about your therapist on the Internet.

If you meet the above criteria and are interested in participating in the study, you can access the survey at:

http://www.surveymonkey.com/s/finalclient

If you do not qualify for the study but you know others who might be interested in participating, feel free to forward this notice or URL. You may also share our research page with others on Facebook.

Thank you for your interest and participation.

Sincerely,

Keely Kolmes, Psy.D. moc.liamhsuhnull@semlokkrd

Daniel Taube, Ph.D., J.D. ude.tnaillanull@ebuatd

Those who want control over Locations should take the following steps.

1. Log into your Facebook account and in the upper right hand corner where it shows Account, click on that and drag down to Privacy Settings.

2. Here you will see what you are sharing on Facebook. Check to see what is selected for Places I Check In which may be set up as “Everyone,” Friends of Friends,” or “Friends Only.”

(Clicking on all images will let you view them in large size.)

3. If you want to modify the setting, click on Customize Settings at the bottom.

4. This will bring you to the following screen.

5. If you want the greatest level of privacy, you would make sure three things are selected here:

First, make sure “Only Me” is selected for “Places I Check In.”

Second, Disable “Include me in People Here Now” after I check in. Enabling this will allow others to see if you are at the venue (feel free to click the “See an example” link on Facebook to see what this will look like to anyone else checking in).

Third, at the bottom, make sure “Friends can check me into Places” is Disabled.

You can read more about the new feature and the concerns of others on mashable and also on Violet Blue’s blog in which she publicized the potential problem raised by @RodBegbie about what happens when someone adds your home address as a venue on Facebook. It sounds as though users will have to go through a tedious process of flagging a venue and then waiting for Facebook to respond in order to get their personal information removed.

The course is Digital and Social Media Ethics for Psychotherapists: Clinical and ethical considerations for psychologists, counselors, and clinicians using the Internet. You can earn 8 CE units by completing this course.

The course offers CE Credits for Psychologists, MFTs & LCSWs (BBS), Social Workers (ASWB), Counselors (NBCC, NAADAC), Nurses (BRN) & More. Find out more about the available CE accreditation.

Course description:

The Internet and social networking are offering a number of new clinical and ethical challenges for those who provide face-to-face mental health services. These challenges include extra-therapeutic contacts between therapists and their clients, questions about what distinguishes personal and professional activities online, and a lack of clearly developed policies related to our online behaviors and interactions.

This unique and first-of-its kind course offers an introduction to various social networking sites and activities and provides guidelines for how to manage the concerns that may arise for practitioners who are using these sites. Applicable ethical standards will be addressed. While this course focuses on issues that may be of concern to clinicians who provide online therapy and who also maintain a presence on social media sites, online treatment is not specifically addressed in this course.

The first section of the course is an Introduction to the clinical and ethical issues that get raised for psychotherapists using Social Media. The second section addresses online transparency of both clients and therapists, inclusive of what therapists may intentionally or unintentionally make available online, and whether they should access client information online. Section three looks at friend and contact requests on sites such as Facebook, MySpace, and LinkedIn, and also examines the challenges of Facebook business pages and the blocking feature on such sites. The fourth section addresses Twitter, Status Updates, and Location-based check-in sites. The fifth section discusses the ethical issues that are raised by consumer review sites and business listings. Section six focuses on email exchanges between therapists and clients, record keeping, and digital security. Section seven provides sample Social Media Policies, and section eight, the last one, includes links to ethics codes for psychotherapists, and additional online resources.

Media psychology

To begin with, let’s be clear that media psychology has some competing definitions.

A new generation of media psychologists is fighting to make clear distinctions between the traditional view of media psychologists: clinical psychologists who appear in the media (for example, on talk shows and reality TV) and those who actually specialize in both media technologies and psychological theory who are studying the uses, experiences, and impact of media on our lives.

This post focuses on the former understanding of media psychology, and not the latter. It is geared towards clinicians who are venturing into social media with the intention of interacting with online audiences.

Many psychotherapists don’t consider a social media presence to be similar to having a television or radio show with thousands of audience members. In fact, most of us start out blogging and tweeting to an audience of zero, never sure how many readers will eventually see our sites. Fewer of us have received any training in media psychology.

However, if you’re a psychotherapist using social media to promote your practice or provide mental health related information, don’t fool yourself: you are acting as a media professional. Social media has become one of the fastest ways to reach an audience, and it often leads to other opportunities to educate and connect with the general public (e.g., interviews, public speaking, and writing articles). It’s important to recognize that your media presence can quickly expand in ways you may have never anticipated.

If you’d like to use your blog or Twitter to broadcast health information, it’s smart to do some research and learn about the ethical responsibilities and potential conflicts that can arise when acting as a media professional. This post will introduce you to some things you should consider when creating a social media presence.

What is your role with your subscribers, readers, and followers?

Who is your audience and how do you plan to interact with them? Are they potential clients? Are they other mental health professionals? Are you educating people about mental health in general, or about your specific areas of focus? Are you trying to give an impression of how you work to market your services? Perhaps you simply want to pose questions to an audience of other clinicians about areas of research, best practices, or challenging aspects of clinical care?

Establishing a professional relationship

If your goal is to encourage potential clients to contact you, you need to take care in how you respond to those making public clinical contact with you. It is easy to violate confidentiality and create an archived record of such a violation when responding to someone asking about becoming your client.

Here is an example: as more people follow me on Twitter, I sometimes scan my @reply list of messages and see replies from people asking about whether they can schedule a session. Others will post public messages and ask how I might diagnose their symptoms. Obviously, we cannot begin a clinical relationship in public and DM-ing (direct messaging) a potential client on Twitter is unwise since it is a non-secure site. Lastly, of course, we may not want to appear rude by ignoring the request entirely.

But it’s not always practical to respond to every query, and certainly not in public.

My best solution has been to Tweet a general reminder now and then that I cannot respond on Twitter to any requests to engage my services and that the best way for people to contact me if they are interested in becoming clients is to directly phone my office and schedule a phone interview.

Some of the legal issues involved in managing potential clients on blogs or other websites are addressed by Recupero (2006). She points out that advice-giving over the phone may be enough to establish a doctor-patient relationship and that responding to email may also create a legal duty. Therapists who enable and respond to comments on blogs, or who reply to postings on Twitter should be mindful as to the potential for such responses to be read as prescriptive or advice-giving. Give thought to whether you wish to engage this level of clinical contact, along with the legal and ethical responsibilities that follow.

Also be aware that other risks arise when current patients use such forums to interact with you. These interactions may become a part of the patient’s legal chart. One way I address this is by outlining in my Social Media Policy that current clients should not use social media sites to interact with me, and that they should use the phone instead.

Responding to Interview and Guest Writing Requests

Getting your point across

Sometimes, someone who has read your blog or seen your Twitterstream may contact you to request your participation in an interview. You may be comfortable with print media but not radio or televised appearances. Anyone considering doing live, taped media appearances should should strongly consider obtaining consultation on managing media appearances. For any interview, request an advance list of the types of questions they plan to ask. This will help you prepare and collect your thoughts. Then make your own list of main points you want to be sure to address. This can help prevent the painful experience of later finding your well-intentioned thoughts misquoted or feeling that you missed an opportunity to get your message across.

Some people do email interviews which can give you the chance to be careful and thorough and edit your responses. But most print interviews still happen over the phone. Be attentive about not being led astray or talking about off-limit issues whether they be about your incomplete data findings or specific clinical examples that could reveal more than you intend. Many interviewers are sensitive and respectful to those in our profession, but some people may be persistent about digging for a story and you need to have good boundaries in such scenarios. This can be challenging to a media newcomer.

Some interviewers will provide you with a draft or your comments to review pre-publication and this is a good time to clarify if you feel you’ve misspoken. But many media sites will not grant you this opportunity, so you’ll want your first shot to be fairly focused.

Maintaining confidentiality and obtaining informed consent

Be extremely thoughtful when you are asked to share clinical examples. Some people may invite you to chat or write stories about your experiences with your clients. Prepare in advance for how you plan to respond. Consider what it will be like for any of your clients to read the story or interview later.

If you are invited to speak or to give a training to a group of professionals, be advised that many such lectures now get recorded, webcast, and tweeted. This means that you are no longer simply presenting to the group of people who is in the room with you, but your presentation may reach many people who you cannot see, and people may access it later.

Some clinicians believe that if you obtain a client’s consent, if you mask the identifying details, or if you show a draft of the writing to the client and let him approve it, it is permissible to share such clinical material with the media in certain contexts. Other clinicians are highly protective of what happens in-session. These clinicians believe that even asking for client consent or participation in the creation of such documents is intrusive and contaminating of the therapy process. It certainly could be perceived by some clients that your own media pursuits or desire for success are eclipsing your commitment to their clinical care. It pays to be prudent and to weigh clinical considerations before thinking about potential benefits to others or to your visibility.

If you do plan to regularly blog, tweet, or speak to news sources about any of your casework, you should first obtain informed consent from your clients. Clients need to be made aware that this is something you do and they should understand what your procedures are to ensure their privacy and confidentiality. You do not want your clients to be surprised to find any details of their work with you that you have been posting without their knowledge and consent, even if you are masking identifying information.

Providing commentary on public figures or news items

One opportunity media psychologists have is to educate the public about the ethics and responsibilities of our profession. Those of us providing outreach to the general public are frequently asked to comment on news items or public figures. I’ve had followers on Twitter ask for my professional opinion on celebrity behavior. Rather than ignoring these queries, I use such requests as chances to explain that I cannot ethically offer diagnostic impressions about people I have not assessed or treated. Further, I explain that when someone does utilize my services, their treatment stays confidential.

Responses of this nature can provide an important counter-example to many of the pop-psychology figures in the media. The public may get the impression that clinicians are delighted to offer diagnostic assessments of people they’ve never evaluated. We have to take care not to comment on such things and this can be a teaching moment for the public, about what we do and our ethical standards.

That said, we can, of course, offer general psychoeducational information to others, and there are often ways to reframe our responses to these questions so that we can provide helpful information to others.

Other issues related to client rights and dignity

Whose status update is this anyway?

Some people may believe that even on locked accounts, it is safe to blog or Tweet about cases.

Remember that friend networks are not consultation groups. Even without names, sex, or ages in a post, if you mention the presenting issue or even when the client has met with you, this can be enough detail to identify your client to others. It can feel particularly compelling to post status updates about challenging cases, crises and traumas, clinical successes, or strong countertransference feelings. Remember that you do not want people checking your feeds for mention of themselves, their acquaintances, or out of voyeuristic curiosity. While it may feel like you are simply sharing aspects of your life, remember that this is confidential clinical care and HIPAA violations are ethical breaches subject to up to $250,000 in fines or imprisonment.

This issue has gotten more press recently as there have been several publicized cases of HIPAA violations on social networking sites. In October, 2009, New England Baptist Hospital banned employees from using social networking sites due to concerns that hospital workers were sharing too much about patient care. In June, 2010, a San Diego county hospital fired five nurses for discussing patient information on Facebook.

This is a major emerging professional challenge as social networking increases and sites continue to encourage frequent sharing of daily activities. At the same time, providers continue to have vague notions about the reach of their postings and whether they are sharing aspects of their own day or their client’s day.

Conclusion

This article covered a basic introduction to some of the issues that can come up for clinicians venturing into social media. Having a social media presence can be a highly rewarding experience, but it does require thought and care. For more comprehensive information about media psychology, I recommend perusing the references below. Of special note is the McGarrah, et al, piece: In the public eye: The ethical practice of media psychology [pdf] which provides more in-depth information and is essential reading for anyone venturing into media psychology.

References

Behnke, S. (2008, April).  Reflections on media ethics for psychologists. Monitor on Psychology, 46-47.

McConville, C. Hospital cuts off use of Facebook. Retrieved June 12, 2010 from http://news.bostonherald.com/business/healthcare/view.bg?articleid=1204514

McGarrah, N., Alvord, M., Martin, J., & Haldeman, D. (2009).  In the public eye: The ethical practice of media psychology.  Professional Psychology: Research and Practice, 40, 172-180.

Recupero, P. R., Legal Concerns for Psychiatrists Who Maintain Websites. Psychiatric Services, April, 2006, Vol. 57. No. 4, 450-425.

Recupero P.R., E-mail and the psychiatrist-patient relationship. Journal of the American Academy of Psychiatry and the Law, 33:465–475, 2005 Retrieved June 15, 2010 from http://www.jaapl.org/cgi/content/full/33/4/465

Rutledge, P. What is media psychology? Retrieved, June 28, 2010 from http://mprcenter.org/?page_id=16

Stickney, R., Hospital will fire workers in Facebook scandal. Retrieved June 12, 2010 from http://www.nbcsandiego.com/news/health/Hospital-Fires-Emps-in-Facebook-Scandal-95794764.html

Wynn, P. (2010, January/February). Brave New World of Social Media: Social networking is transforming the way medical students communicate with one another, but is online content meeting professional standards? The New Physician. Retrieved June 12, 2010 from http://www.amsa.org/AMSA/Homepage/Publications/TheNewPhysician/2010/0110SocialMedia.aspx

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) An introduction to media psychology for bloggers and tweeters. Retrieved month/day/year from http://drkkolmes.com/2010/06/28/an-introduction-to-media-psychology-for-bloggers-and-tweeters.

Dr. Young and I thought we would share some of our musings about this with readers.

Dr. Young: After Dr. Kolmes and I exchanged information and thoughts about Google Buzz, I decided to investigate further how my social media boundaries might be affected. The lack of information from Google about privacy settings and Buzz led me to consider whether I needed to maintain a Google Profile and what its value is.

So I Googled myself!

I do this periodically and encourage anyone to do the same to gain information about your online presence. I saw that at the bottom of my search page Google was linking me to other people “In my Social Circle”, information apparently culled from other sites like WordPress (where I blog) and Twitter. It was not immediately clear whether this was information the general public has access to or only for my benefit.

[You may click on all images below to see larger versions.]

Dr. Kolmes: The results from People in Your Social Circle is similar to an issue I faced a year or so ago when a site called Delver was combing my professional LinkedIn profile and merging it with my non-professional accounts due to crossover of friend networks. This was the primary reason I decided to make my LinkedIn profile non-public. I don’t want search engines to put together a picture of my identity based upon my connections, and it feels invasive to me after the extensive work I’ve put into separating my professional and personal lives on the Internet. Google does provide information on how to change and troubleshoot Your Social Circle, but it can be time-consuming to have to constantly manage this information.

Dr. Young: Navigating social media as a psychologist, and a consumer, and determining ways to do so ethically is a challenge! What the Google Buzz debacle reminded me is that this is brand new and constantly changing territory. It is not enough for us as clinicians (or really anyone who needs to maintain a separate professional online presence) to create good practices and think that will be enough. We have to stay on our toes and educate ourselves about changes. It is crucial to have information about what is available in advance versus responding after the fact. I find it absolutely necessary to have other social media savvy mental health professionals to consult with.

Dr. Kolmes: I completely agree with Dr. Young that it’s essential to have other social media savvy professionals with whom to consult. It is hard to find other professionals who are venturing forth into social media with shared values and caution. I am very grateful for those with whom I’ve made a connection. I see people on the extremes: those who are highly critical and believe that any social media presence is de facto a dangerous thing that compromises therapy relationships; or others who are using social media in careless ways potentially compromising basic ethical principles. It’s hard to find professionals who are visible on social media but are applying a thoughtful, principled standard to such usage.

Providers of confidential services may want to carefully consider which Social Content they wish to merge in their Google Profiles. I opted to remove Twitter from my Google profile for my business, as I did not want people looking at my Google profile to see a list of my Twitter followers. You can do this by accessing the Social Content settings on your profile and then you can de-select content that you do not want added to your profile. I also disabled Google Buzz completely.

Dr. Young: Like Dr. Kolmes, this experience has me reconsidering how I move through the social media world and what sites I connect to each other. More recently Facebook is encouraging users to link to other external websites. We need to think before acting in such situations. We also need to continue to request that social media sites provide clear privacy policy information and settings.  I have also opted to switch from gmail.com to hushmail.com (which provides free and encrypted email services) for sensitive professional purposes.

I want to thank Dr. Young for taking the time to participate in this exchange with me and for alerting me to the People in Your Social Circle issue in the first place.

More and more sites are expanding the scope of their services to include social networking and sharing that their users never anticipated when they first signed up for the services. The latest such move is happening on Yahoo, where Updates will soon be broadcast to your Contacts, à la Google Buzz. You can find out more about how to opt-out of sharing on Yahoo, thanks to Kurt Opsahl over at EFF.org.

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) People in Your Social Circle: Dr. Kathleen Young Chats with me About Social Networking Challenges for Clinicians. Retrieved month/day/year from http://drkkolmes.com/2010/06/07/people-in-your-social-circle-dr-kathleen-young-chats-with-me-about-social-networking-challenges-for-clinicians/.

In the coming weeks, I plan to create a similar page for the posts that are more specifically geared towards demystifying therapy for consumers.