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.

From the email:

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

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

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

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

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

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

Update: 8/5/10

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

Hi Keely Kolmes,

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

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

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

FAQs:-

WHY AM I GETTING THIS CALL CONFIRMATION?

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

WHY DO I BENEFIT?

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

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

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

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

—
The folks at PsychologyToday.com
—

*Don’t reply to this email*

© 2010 Keely Kolmes, Psy.D.

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

Ofer Zur has written an article called Record-Keeping of Phone Messages, Email and Texts in Psychotherapy & Counseling. This article is a response to Zur’s piece.

In Zur’s article, he questions whether phone messages, texts, and emails are part of the clinical record, and he asserts that texts and emails that simply discuss scheduling issues do not need to be included in the clinical record. Psychotherapists should be aware that there is a difference between the clinical record and the legal record. Clinicians who are engaging with clients via text message, email, or social networking sites need to be aware that all interactions that are part of treatment are part of the legal record. Whether a therapist chooses to include these contacts in the clinical chart is separate matter.

To offer a counter position to Zur’s point, one important reason to document all contacts, including administrative messages around scheduling issues is that one cannot necessarily know whether something has clinical importance until a pattern emerges. A clinician may believe that a simple schedule change isn’t meaningful. But by failing to document such contacts, it may take longer to recognize when these communications become clinical material. For example, it could take months to notice that a client tends to cancel and skip a week of treatment following sessions in which he discusses particular themes or that he adjusts his appointment time every six weeks. Without a consistent record of such interactions, how can a therapist recognize such themes? When we are carrying a full caseload and we have multiple messages to return each week, it can be easy to miss a developing pattern if we fail to make any notation.

My current policy explains to clients that I print emails and place them in the chart. It is also my practice to document phone interactions, as well. Jeffrey Younggren, Ph.D., Risk Management Consultant to the American Psychological Association Insurance Trust, points out that “the policy of saying that you would do this and failing could be problematic.  I think saying nothing is better.” Thus, if your office policy specifically states that you print out all emails, you are setting yourself up to have to follow through on this practice at all times.

Daniel Taube, Ph.D. offers an alternative: “Rather than saying that all emails will be printed, you can simply state that all emails become a part of the record.” Dr. Taube explains that since such records are legally discoverable whether or not you are printing them, this conveys accurate information to clients while not requiring a therapist to manually print out every email if she chooses not do so.

Generally, it takes most people a minute to simply enter a notation into the chart with the date, the time, and information recorded. If such exchanges occur via email this makes it even easier to print up and store them in the chart. I believe that taking this extra minute can potentially provide clinically useful information and is worth the time, although it does exceed the standard of care.

Some clinicians feel that taking this extra step to surpass the standard of care is unnecessary and burdensome. Ultimately, each clinician will have to weigh their own approach to risk management and clinical care to find the solution that best fits her own practice.

References

Taube, D. O., (in press). Confidentiality for California psychotherapists. pp. 259-267.

Zur, O. (2010). Record-Keeping of Phone Messages, Email and Texts in Psychotherapy & Counseling, Online Publication, Zur Institute. Retrieved June 28, 2010 from http://www.zurinstitute.com/digital_records.html

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) Additional comments on documentation for clinicians. Retrieved month/year from http://drkkolmes.com/2010/07/14/additional-thoughts-on-documentation-for-clinicians