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Digital and Social Media Ethics for Psychologists
May 20, 2012
1:00pm to 4:00pm. Registration at 12:30
3 CE hours

Sponsored by
Santa Clara County Psychological Association
Location-Palo Alto University
5150 El Camino, Suite 22, Bldg C
Los Altos, CA

Course Description:
The Internet and social media 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 from professional activities online, and a lack of clearly developed policies related to our online behaviors and interactions.

This course offers an introduction to digital ethics and to various social networking sites and activities. It provides guidelines for anticipating and managing the problems that may arise for practitioners who are using these sites. Applicable ethical standards will be addressed. The instructor will incorporate vignettes and encourage discussion to address the different ways clinicians are addressing these issues.

Learning objectives:
• Describe social media and summarize several popular social media sites and services.
• Distinguish between one’s personal and professional activities on the Internet.
• Identify the ethical challenges that may arise from engaging in activities on the Internet.
• Construct a social media policy for one’s office to address potential boundary issues with clients.

Presenter’s Bio:

Keely Kolmes, Psy.D. is a licensed psychologist in private practice in San Francisco, CA. She serves as Director of Digital Communication for APA Division 42, Psychologists in Independent practice. Dr. Kolmes writes, does research, and provides consultation and training on clinical and ethical issues related to social networking and technology. Her Private Practice Social Media Policy has been frequently cited and is a recommended sample document for clinicians by the APA Insurance Trust. She has published a New York Times Op-Ed on the challenge of consumer reviews of mental health services. Her professional website is www.drkkolmes.com where she keeps her blog, Mindful Musings: www.drkkolmes.com/blog. She can also be found on Twitter as @drkkolmes

CPA is approved by the American Psychological Association to sponsor continuing education for psychologists. SCCPA maintains responsibility for this program and its content.

And then, in an instant, it can also take so much away: feelings of pain, jealousy, feeling left out, or trying to interpret messages from pixels on the screen.

The Internet makes it easy to communicate without having to talk to people like some of us digital immigrants did in “the old days.” Don’t forget that the human relationships you most value do require some direct, face-to-face communication sometimes as part of their regular care and feeding.

Since so many of us are living our lives online these days, here are my six pointers for avoiding injury to yourself and others on email and social media.

1. Be careful of “heat of the moment” posting.

It’s so easy to impulsively respond to an email or a tweet or a wall posting when you’re feeling hurt or angry. But if you find yourself composing something when you’re feeling angry or shaken, try making it into a draft and giving yourself at least a 24 hour cooling period before clicking send.

If you have a trusted friend who you know to be a careful and balanced thinker or communicator, perhaps run your posting by him or her.

If you goof, and post something that maybe you shouldn’t have, you can still self-correct and delete it later. An apology may sometimes be a step towards a better interaction, as well.

2. Don’t use status updates as a passive-aggressive way to communicate something to just one person.

If you know you are really posting that tweet or status update for an audience of one, and it’s an indirect way to get something off your chest, try a direct message to the person you’re trying to to reach instead. Or better yet, send an email (or – gasp! – pick up the phone and call) and see if they are available to talk in the near future.

Don’t use vaguebooking or passive-aggressive posts to try to get attention. You may irritate people, and you may find that it doesn’t really wind up getting you what you want. Of course, private jokes or sweet messages can sometimes become a status update. But beware if you are using your twitterstream or Facebook Wall or G+ account as a way to beat around the bush.

3. Never unfollow or unfriend someone out of retaliation just because they unfollowed you.

Yes, it stings to find out that someone has stopped following your tweets or is suddenly showing up as a recommended Facebook friend when you know you were connected just a week ago.

If it’s a close relationship, you can always send a note and say you’ve noticed they stopped following you and ask why they did so. Don’t do this unless you are prepared to hear their answer.

But if you are still following them on Twitter and you like their tweets, don’t unfollow them to “get even.” Try giving it 30 days or so to see if they are still providing valuable content to you. If it’s still bugging you, and the relationship is close enough, you can ask why they took you off their Follow list.

If what follows is a “difficult conversation,” see my blog post on how to have difficult conversations.

And try those off of the Internet! Oh wait, that’s item #5!

4. Don’t obsessively Facebook, Google, or Twitter-stalk your ex (or the person your ex is now dating).

Of course, it’s tempting to find out what has happened in someone’s life when you’re no longer in it, and the Internet has made it ridiculously easy to browse photos, news, and updates on the lives of people who are no longer in our lives. In the old days (yes, this is a phrase I am now old enough to use), people might drive by an ex’s house in a moment of longing or self-loathing. But now we can just sit home in our pajamas and look at their social media profiles to find out what’s new with them.

But this has become a new form of self-injury for many people. Sometimes, it can feel like a compulsion and it can be hard to stop. If you find you are doing this, consider employing some harm-reduction strategies such as using the “block” function or imposing time periods during which you’ll stay away from the offending profiles.

Try 14 days of not looking. Then try 30 days. You may find that not looking helps you move forward and helps stabilize your mood.

If it helps, enlist a friend whom you can call when you have a weak moment. Ask your friend to help support you in choosing something healthier to do rather than checking these profiles.

Chances are good that the profile will still be there to peek at once you’ve had 30 days of sobriety from checking your ex’s profile.

5. Try to keep important and difficult conversations offline.

The online disinhibition effect can lead people to sometimes get closer online and share more than they would offline with positive effects. But it can also lead some folks to say things that are more cruel and toxic than what they would say if they were chatting face-to-face, looking into someone’s eyes and seeing how their words land. This can be problematic, if you want to process hard things in a friendship.

One of the worst things you can do is tell someone that something should happen in an offline chat, but then dump your side of the conversation into an email. That’s unfair and it only makes sense that a person would want to respond to that email.

So do both of yourselves a favor: if you think something warrants a face-to-face conversation, don’t start it over email. Send an email and say, “Let’s get together and chat, I’ve got some stuff I wanna talk to you about.” Or pick up the phone and do the same.

Unless you’ve got a proven track record with someone who also likes to process things over email, don’t assume this is the best way “to talk.”

6. Avoid inflicting FOMO on your friends (and yourself).

While it’s great to post photos and updates of all the cool and groovy things you do in your life, remember that people are going to see these updates who may feel very hurt and left out when they find out you had a big birthday bash and neglected to invite them.

Be mindful of what it means to have wide audiences who are now privy to your every social engagement and think about whether you really want to share these things with everyone or whether you want to create filters and friend groups so that you are not in inadvertently pissing off half of the folks you call your friends.

And if you’re prone to FOMO yourself, start booking up your own social calendar rather than cruising for online information of what you’re missing out on. If you’re feeling like you’re missing out on too much, it may be a sign that it’s time to work a bit harder on creating more offline activities for yourself than online ones.

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

And it’s really not.

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

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

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

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

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

We will soon be writing up our findings to submit for publication, but I’m pleased to be able to share this data with all of the folks who participated in our research and those who helped us reach out to potential participants. We could not have done this without the magic of social media and all of your help!

I’m very appreciative and I hope that our findings help bring greater awareness and understanding to how the Internet and social media are impacting the psychotherapy relationship.

Without My Consent is intended to provide resources and information to victims of online harassment to help them find safety, seek justice, and stand up for their rights. We also hope to provide psychological resources for people who have been harmed.

It is also our hope that our site serves as a deterrent to those who may be thinking of doing harm to another individual. These individuals may wish to seek help to process the intense or disturbing feelings that might lead them to want to lash out against another person in such a way.

This project was recently mentioned on June 2, 2011 in The New York Times story How to Unmask the Internet’s Vilest Characters. This article discussed one of Without My Consent’s strategies: encouraging victims to file suit pseudonymously.

Keep your eye on us. There will be some interesting news and updates coming soon.

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.

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

Thank you to everyone who participated in our survey. The summary of the results of the research Dan Taube, J.D., Ph.D. and I conducted on psychotherapists who have had intentional and accidental extra-therapeutic encounters with their clients on the Internet are posted on my research page. A larger slideshow can be viewed here.

To read a brief lit review and description of the research, please see our article Clinical implications of therapist-client interactions on the Internet: Boundary considerations in cyberspace.

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.