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:

1. Learn balance & self-care strategies early

It’s common sense that we can’t really care for others if we are unable to care for ourselves. But this lesson can be a difficult one to learn as a beginning therapist. It is a huge adjustment to learn how to manage a full caseload of different people with different personal stories and challenges. When you’re just starting out and also working extra hard to master different techniques and approaches to different problems, you may be especially vulnerable to taking your work home and thinking (perhaps even obsessing!) about your cases and how you might better help your clients.

Interns are especially vulnerable, and they can sometimes feel abused by the training process: you will be working long hours, frequently without any financial gain, and sometimes with challenging cases or groups of people. This is a great time to learn what you need to re-balance yourself. Perhaps it’s yoga and meditation or exercise. Maybe it’s time with friends and family. Maybe it’s a warm bath by candlelight at the end of the night, or cooking dinner, or engaging in a marathon of your favorite TV shows on DVD. But self-care can also include rituals that help you re-charge between sessions too, such as a five minute breathing exercise or stretching.

If you feel overwhelmed by your cases or you believe that your caseload is unbalanced (too many clients dealing with trauma, for example) talk to your supervisor and try to get help reducing your number of intakes or see if you can create more balance in the different types of new cases you take on.

2. Avoid isolation & try co-working

One of the other painful lessons of graduate school can be learning to say no. If you are also juggling a dissertation, family life, or a part-time job, you may find you have to say no more than you’d anticipated to a lot to social activities and fun. After just a few weeks of this, you may feel extremely socially deprived.

Don’t forget that socializing can be a huge stress reliever and that there may be ways to integrate social contact into productivity. Co-working is one way to do this. Try studying with a pal or with a small group. Make work dates in coffee shops or set up a work date that includes a dinner break. You may feel less isolated and socially impoverished if you are able to connect with a friend and get some work done.

You may also find that you have other friends who are not in school but who have projects they need to work on. Learning that you can connect with someone else and keep company while being productive or working on different tasks is a nice compromise and can avoid black or white thinking around whether you can make plans.

3. Start a consultation group

“Why would I need a consultation group?” students ask me. “I already have group supervision and other classmates.” Sure, you have several built in support groups, but sometimes it’s nice to develop a smaller team of people to meet with who are not affiliated with a class or an agency. If you have tension with another intern or if you ever wrestle with how to communicate about something challenging with a supervisor, a consultation group is a great way to learn to formalize professional consultation and get ongoing support and feedback from your peers.

I started my own consultation group in my second year of graduate school and we have met every 1-2 weeks for the last thirteen years. I think it’s safe to say that no other clinicians know my clinical thinking better than those in this group. As we developed from graduate students to licensed clinicians, our group provided feedback and support for professional milestones including the dissertation, licensing exams, and job-seeking (we have served as professional references for one another).

My recommendations for starting your own consultation group are to try to find a balance between safety and growth. Of course, you need to find people with whom you feel comfortable sharing your biggest struggles, challenges, and vulnerabilities. This may make it tempting to select others who have similar approaches. But it can provide great richness to consult with people who represent other theoretical and sociocultural perspectives.

Learning how to respectfully engage with other colleagues who have different approaches or areas of expertise is an invaluable experience. Of all of the professional commitments I’ve taken on, I feel that starting my own group as a graduate student was one of the wisest investments I ever made in my future as a psychologist.

Summary

Graduate school is hard. You’re putting part of your life on-hold to learn something new and invest time, money, and a good piece of your heart in developing new skills. Learning to provide psychological care to others has its own unique stresses and challenges. I hope that my tips can help graduate students to support their own mental and emotional health and move on to becoming successful post-graduates.

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.

Email Tips for Clinicians

Nearly everyone uses email nowadays. I would guess anyone who is reading this right now has an email account. While many clinicians avoid social networking sites such as Twitter, Facebook, or LinkedIn they may still use email to keep in touch with family or to access email lists and exchange notes with colleagues.

Those who publish their email addresses with their office information are likely to see more clients using email as the point of initial contact, even if it is their intention to dissuade clients from using email as part of treatment. Some others may be comfortable with ongoing use of email as a way to quickly convey appointment changes to clients or even to send files or documents that are related to treatment.

If email has been or will be a part of your clinical practice, there are some important factors to consider.

Initial Contact

A new challenge for clinicians who are visible in social media is that many clients are obtaining clinicians’ email addresses and using them as a point of initial contact. Very often these emails may contain specific and extensive information along with requests for professional advice or information. Clinicians should be very careful in responding to such queries as their response can unintentionally initiate a therapist-client relationship. Giving any advice or offering diagnostic information can be perceived by a prospective client as beginning a treatment relationship. Sometimes the client sending such emails may reside in another state or another country and may not even be appropriate for our practice. I typically respond to such queries with a simple note. I also take care to delete the quoted text of the original email, in the event that someone else has access to it:

I am legally and ethically unable to provide psychological advice,
diagnoses, or assessments via email to people who are not my
patients.

If you have concerns you wish to discuss, you may wish to consider
contacting a therapist who lives in your area and scheduling an
appointment to discuss these matters with them.

Bear in mind that situations involving initial emails may be stickier if the individual sends information related to intent to harm self or others. Choosing whether and how to reply in cases like this should involve consultation and may entail locating crisis resources in the client’s location.

Software Security

Recent privacy flaps such as what happened with Google Buzz illustrated for me how important it is to use an encrypted and secure email address if you plan to exchange any email with patients. Digitally signed and encrypted email can be exchanged on sites like ciphersend or hushmail, and some offer secure forms that you can add to your website so that client data is protected. Be sure that this is the email address you put on your cards, website, and any public information. Also, if you are having mail notification sent to another email account to alert you that you have a message on a secure site, select the option that does not show the sender’s name/address in the forwarded mail. This ensures that you are not advertising secure mail and then having client data sent to a non-secure site which would be misleading.

If you have clients who want to use email to send you anything, have them come up with a password that you can use to encrypt each message. This can easily be included on your intake form. Each client should have their own unique password that only you and them know. Clients may also want to create their own secure address on one of these sites if they wish to bypass the password step and exchange secure messages with you.

If you are advertising use of secure email, and you use any web-based referral sites which mask your email address but allow clients to email you from the site, be sure you have linked all these business-related services to your secure email address to avoid security loopholes and being misleading to clients. Do the same if you use sites like PayPal or other credit card payment sites which are sending you information related to the people you treat. And be aware that email sent from data forms on these non-secure sites will compromise privacy. If you use any kind of VOIP messaging service which sends voicemail messages to your email account (sometimes with names/numbers attached to messages), also make sure you’ve selected a secure email address to which they are sent. In essence, clean up all of your various points of contact to be sure that all information related to clients goes to a secure account.

If you are someone who has used another email address with clients and you are transitioning to a service that offers encryption or more secure email, make sure you remove all client names and emails from your former email account so the names are not stored in your contact list. Remind clients to do the same for your old email address.

Lastly, it’s good to be cautious when responding to email from accounts where email was forwarded. Some sites, such as Google, have occasionally exposed the forwarded email address even when you have chosen reply to show  the originating address. If you are writing from an email address you’d prefer to keep personal, it may be safer to log out and log into the appropriate email account to respond to some messages.

Hardware Security

It goes without saying that if you are downloading emails to your computer or accessing them via a mobile phone, then you should at the very least be logging out of sites when you are done reading messages and using a password on your phone or computer at login or wakeup to prevent others from accessing these accounts.

Be aware that cellphones and laptops are frequently lost or stolen. Encrypting messages or other client data is an important way to protect any client data stored on these devices in the event of loss or theft. If you keep a separate laptop at work, don’t leave it on your desk after hours. Instead, store it in a locked file cabinet.

Be cognizant that we do not just have to be concerned about what happens on our end with messages to clients, but we should also be protective of what may happen on the client end. Even with protections in place, emails can be viewed by system admins or others in an office. If your client is in a public place and leaves her computer unattended, it is possible that anyone walking by may read your message.

Spouses or significant others may also have access to a client’s computer or cellphone which may contain email messages. This is another reason to keep disclosure of sensitive material out of emails, even when security measures are taken. A confidentiality notice in email is also a good reminder to clients about being conscientious about the use of electronic communication.

Social Networking Sites

Do not use the same email address you give your clients when you create accounts on social networking sites. You can post your practice email address publicly, but if you want to avoid popping up as a “suggested” friend or contact to your clients on these sites, create a different email address for logging into these sites. I also include in my own policies that clients who see or find me on such sites should never use the direct message systems on any of these sites to contact me, as they are not secure. Messages sent and received on these sites may also become a part of the legal record of treatment and may need to be incorporated into the client’s chart.

Shared Email Lists

If you are a member of any email list, there is the potential for one or more clients to also be on the same email list. These could be either personal or professional lists. Social circles do overlap, and cultural and community interests easily draw people together and make the world a smaller place. What this means on the Internet is that it is also very possible that you may discover you are on a shared email list with one of your clients or with others who know or are closely related to one or more of your clients.

Given these possibilities, you may have to choose carefully at times which email address you want to use and how much you care to disclose about your personal life on such lists. There are pros and cons for different approaches.

If you are using the email list for personal support, community, or socializing, you may prefer not to use your professional email account–but this opens up the possibility that your personal email may be discovered or shared with those you didn’t want to have it. On the other hand, sticking to your professional email address for all types of interactions on the Internet may make you identifiable as a clinician in places you’d prefer not to be identified, and you may not wish to publish personal things on the Internet with your professional name.

Some prefer one email address for all interactions while others feel that having a personal email and a professional email address makes for stronger branding and less blurring of personal and professional roles. Clearly, this is something to be thought through and your choice will depend upon your own comfort, as will the amount of personal sharing you’re comfortable doing on places where your messages may be accessed or archived.

Policies

It is appropriate to make clear and explicit policies for whether and how you use email in clinical care. You should put a statement about this in your policy forms. Clients should be informed about how long it typically takes you to respond to email messages, and they should be informed that email is not appropriate to communicate emergency situations to you. If you do not wish to have clients emailing you for any purpose, then do not put your email address on your website or business cards. If you allow email in specific cases, make this clear.

My own policy states that I prefer to only use email for business items such as changing appointments and it also notes that all emails sent and received are printed and placed in the client’s file. It should be noted that many practitioners feel that it is only essential to document emails that reference clinical material, and there are varying views and practices on whether administrative emails (e.g., schedule changes) should be documented.

Non-Confidential Exchanges

Some may prefer to continue to use non-secure email for professional exchanges that are non-confidential in nature, including listserv use, research, or exchanges with other clinicians. If you decide to use secure email, you can always retain less secure account for non-confidential exchanges. Just be careful not post or publicize this email address on business cards or other public listings and make sure your colleagues know not to give it out to clients.

References

Drude, K, & Lichstein, M. Psychologists Use of E-mail with Clients: Some Ethical Considerations. (2005) The Ohio Psychologist. Retrieved April 28, 2010 from http://kspope.com/ethics/email.php

Kolmes, K. (2010) Google Buzz alarms a psychotherapist. Retrieved April 28, 2010 from http://drkkolmes.com/2010/02/18/google-buzz-alarms-therapists/

Recupero, P.R. E-mail and the Psychiatrist-Patient Relationship. J Am Acad Psychiatry Law, December 1, 2005; 33(4): 465 – 475. Retrieved, April 28, 2010 from http://www.jaapl.org/cgi/content/full/33/4/465

Taube, D.O. (in press). Confidentiality for California psychotherapists (pp. 68 – 108).

Zur, O. (2010). I Love These E-Mails, or Do I? The Use of E-Mails in Psychotherapy and Counseling. Retrieved month/day/year from http://www.zurinstitute.com/email_in_therapy.html

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) Email tips for clinicians. Retrieved month/day/year from http://drkkolmes.com/2010/04/28/email-tips-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.

Please be aware of my upcoming training. And feel free to share the following announcement with anyone you think might be interested!

SFCP Community Members’ Professional Development Salon

The Web 2.0 Psychotherapist: The Therapeutic Relationship and Social Media

Some clinicians are hesitant about having a personal social media presence (e.g., Facebook, LinkedIn, Twitter) but are beginning to explore having a professional social media presence for their psychotherapy practices. The current APA Ethics Code does not explicitly address our activities on the Internet. What does it mean to be “transparent” using social media as a clinician? How might it influence one’s clinical work? What boundary issues do clinicians need to be aware of when they create an online social media presence? What happens when clinicians and clients cross paths in online spaces? Lastly, how can we think about this analytically and bring these new experiences of the relationship into the work?

Speaker:
Keely Kolmes, Psy.D., Dr. Kolmes is a psychologist in private practice in San Francisco who writes and speaks on the intersection of clinical care and social media.

Discussant:
Robert L. Friend, M.D., SFCP Member and Faculty

Moderator: Renée Spencer, M.F.T., SFCP Community Membership Co-Chair

Preparation
In preparation for the Salon, Dr. Kolmes suggests that attendees use Google or another search engine to search for yourself. Please use quotation marks around your name and search for yourself in various formats depending upon names you use on the Internet. For example, she would do the following searches on herself:
“Keely Kolmes”
“Keely Kolmes, Psy.D.”
“Dr. Keely Kolmes”
“drkkolmes”

Thursday, April 8, 2010
7:30 to 9 PM
San Francisco Center for Psychoanalysis
2340 Jackson Street, 4th floor Auditorium
San Francisco

Registration & Fees
This series is free to SFCP members, candidates, and community members. For others, the cost is $35 per meeting payable at the door. Attendance at the previous salons is not required.  Prior salons were recorded on DVD and can be borrowed from the library.  Pre-registration is encouraged but not required. RSVP to 415-563-5815 or to finance [at] sf-cp.org.

1.5 CME/CE credits (pending) for $15.00

The San Francisco Center for Psychoanalysis is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians. The San Francisco Center for Psychoanalysis takes responsibility for the content, quality and scientific integrity of this CME activity.

PHYSICIANS: The San Francisco Center for Psychoanalysis designates this educational activity for a maximum of 1.5 credits as listed for each individual program, AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

LCSWs/MFTs: The San Francisco Center for Psychoanalysis is a provider approved by the Board of Behavioral Sciences, Provider Number PCE623, for 1.5 credits on an hour for hour basis.

PSYCHOLOGISTS: Psychologists attending SFCP events approved for CME credits may report AMA PRA Category 1 Credit(s) toward their CE requirements and are now able to directly submit their verification letters at the end of each renewal cycle using the MCEP credit reporting form that can be found on the internet at: http://www.cpapsych.org/associations/6414/files/mcepaa/files/MCEP_Reporting_Form.pdf

REGISTERED NURSES: The San Francisco Center for Psychoanalysis is a provider approved by the California Board of Registered Nursing, Provider Number 02677, on an hour for hour basis.

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

Course Objectives:
1) Participants will develop a basic knowledge of Twitter, LinkedIn, Facebook, and blogging and how they might be used as an adjunct to one’s practice.
2) Participants will learn how the current APA Ethics Code may be applied to Internet activities.
3) Participants will have the opportunity to engage in discussion about clinical boundaries and the potential impact of both therapist and client encountering one another out-of-session in online spaces.

Commercial Support: None

Faculty Disclosure: The following moderators and planning committee members have disclosed NO financial interest/arrangement or affiliation with commercial companies who have provided products or services, relating presentation(s) or commercial support for this continuing medical education activity: Keely Kolmes, Psy.D., Robert Friend, M.D. and Renee Spencer, M.F.T. All conflicts of interest have been resolved in accordance with the ACCME Updated Standards for Commercial Support.

Last Wednesday, I logged into Gmail to discover that I had a new little Buzz icon. When I clicked on it, I discovered what everyone was tweeting about: I was auto-following a number of people. Some I knew and some I didn’t really know at all. We just happened to be active participants on shared email lists, but we’d never met.  I’d heard the murmurs about Google Buzz, so I knew something was brewing. But what arrived wasn’t what I expected. I certainly wasn’t prepared for the invasive experience of having Google decide for me who I should be following based upon the frequency of our email exchanges. And this was just on my personal email account.

7. Of course, if you use PayPal or have a presence on other sites like Psychology Today on which clients may contact you, switch the email address to your new secure email.

Other resources

For some more Gmail privacy tips, lifehacker has a good post Top 10 Google Settings You Should Know About. Here is another informative post 3 Things You Should Know Before Using (Or Continuing to Use) Google Buzz.

Update: November 2, 2010

Today, Google has notified users of a class action settlement in the lawsuit regarding Google Buzz. An excerpt from their email:

The settlement acknowledges that we quickly changed the service to address users’ concerns. In addition, Google has committed $8.5 million to an independent fund, most of which will support organizations promoting privacy education and policy on the web. We will also do more to educate people about privacy controls specific to Buzz. The more people know about privacy online, the better their online experience will be.

Just to be clear, this is not a settlement in which people who use Gmail can file to receive compensation. Everyone in the U.S. who uses Gmail is included in the settlement, unless you personally decide to opt out before December 6, 2010. The Court will consider final approval of the agreement on January 31, 2011. This email is a summary of the settlement, and more detailed information and instructions approved by the court, including instructions about how to opt out, object, or comment, are available at http://www.BuzzClassAction.com

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) Email tips for clinicians. Retrieved month/day/year from http://drkkolmes.com/2010/02/18/google-buzz-alarms-therapists/.

Yesterday, I posted a draft of my Social Media Policy for Psychotherapy on this blog. I also included a link on Twitter. I made it clear that this was a work in progress and asked folks to feel free to comment or suggest additions. Of all the public and private feedback I received, the section of my policy that garnered the most criticism was the part about deleting clients who become “Fans” of my Facebook Page. I appreciate the feedback, and I may modify the language of this section to soften it a bit. I also need to add sections on use of pseudonyms by both therapist and client and on consumer review sites such as Yelp and Google and Yahoo Business.

Thank you to @susangiurleo and @TriBeCaTherapy over on Twitter for some different perspectives and for raising questions about how it might affect a client to be deleted as a “Fan” from a therapist’s Page. I certainly don’t want for a client to feel hurt or rejected. The very reason I’m creating a Social Media Policy in the first place–and discussing it with clients–is to minimize the potential for such feelings of rejection. I’m making it extremely clear that this policy is universal for all clients and not personal. I’m also explaining my rationale. I want this information to be clear and accessible before such events transpire so that it’s not a mystery as to how I’ll respond. Thus far, I haven’t ever been in a position to have to delete a client from my Facebook Page. I suspect that this is because I work mostly with fairly media savvy adults who care about their privacy. Most who have any interest in my social media presence know how to access it while still retaining their privacy. But this could easily change.

I was asked why I would even create a Facebook Page if I did not wish for clients to become “Fans.” Great question. First, I am fascinated by social media and I swim in it, explore it, teach and write about it. Other clinicians consult with me both in terms of creating and modifying their own social media presence and to better understand how clients may engage online. I also work with clients who live and breathe on the Internet. It’s fairly impossible to specialize in this arena without beta testing things now and then in order to understand how they work from the inside. I also wanted to experiment with Facebook ads (which I’m no longer using) to see if I found them effective for advertising my practice. My Page was one way to attract potential clients to my content, and ultimately, my website.

I initially had strong concerns about establishing a Facebook Page because I worried that my only “Fans,” would be friends and family members and this brought up concerns about my own privacy! And yet, these were the best people to help me first experiment with the Page. I do still have some friends and family members as “Fans” of my Facebook Page. But I now also have people as “Fans,” who are trusted colleagues, clinicians in other cities who I’ve never met, and others who do not practice psychotherapy who just found and appreciate my posts. My Facebook Page allows others to read and share my postings within Facebook, which is nice for those who don’t use RSS feeds, regularly read blogs, or use Twitter.

Back to those who did not like my position on declining to have clients as “Fans.” It was pointed out that clients are grown-ups and I should not be making this decision for them. This is a valid point, but it raises some issues. Grown-up (and non-grown-up) clients may think a lot of things are okay that don’t feel okay to me in my clinical practice. Some of those things might include socializing or exchanging casual emails between sessions or feeling less concerned about the state of my record-keeping. Yes, despite my own commitment to maintaining client confidentiality, my clients themselves can choose to reveal they are in therapy with me whenever and to whomever they choose. However, this does not relieve me of my ethical obligations regarding confidentiality, or grant me permission to solicit client endorsements.

Sure, my clients are grown-ups, but I am also a grown-up running a clinical practice, and as such, I also have a right (and a responsibility) to establish policies and procedures that feel appropriate to me. My Facebook Page is part of my business and I get to set up how I’d like to conduct business on that Page. If a client wishes to disclose their therapeutic relationship with me, they always have the right and ability do so on their own Pages, profiles, blogs, or accounts.

One person said that I should not deny clients the kind of access that anyone else on the Internet has access to which was interesting. However, I am not actually limiting anyone’s access to my professional practice content or information in any way at all. Every piece of this information is on a public Page and “Fans” and “non-Fans” have the same access to it. I’m neither blocking them from accessing the Page nor preventing them from reading anything my other “Fans” can view. They can still see it, read it, share it with others, save it, and so on. The only thing they are unable to do is publicly link themselves to my Page. I fail to see how this is hurtful to a client.

I am not a rock star. I do not need my clients to be my “Fans,” particularly on a site which already has an unstable track record in regard to user privacy. The way I see it, other than the positive interpersonal exchange (pride, recognition, and other warm feelings between client and therapist), the person who stands to benefit the most from getting clients as “Fans,” on their practice Page is actually the therapist. By not accepting clients as “Fans,” I’m taking a stand against cavalier privacy policies in exchange for lower numbers. I’m willing to forgo a few extra “Fans” of my practice on Facebook if the trade-off is that those who might be curious about my clients are being told unequivocally: “You will not find people on this Page who are in treatment with me.”

Hopefully, I’m not short-changing my therapeutic relationships of the positive interactions that can still happen off of Facebook and in my actual office when clients admit that they had a desire to “Fan” or link to me. Other clients simply make mention of my blog or Twitter postings that had special meaning to them and in this way we can together acknowledge their care and interest in my work outside of the therapy room without them having to publicly endorse my presence on a website. Clearly, a client doesn’t have to be a “Fan” or “Follower” for us to both find value in these exchanges and work with the transference privately, within the walls of my office.

The beauty of office agreements and policies is that we all get to craft policies that reflect our own unique beliefs and values as clinicians. If you have a different stance on social media, patient privacy, or clinical care, then by all means create a social media policy that works for you and your practice. It would delight me to see other mental health professionals sharing different policies and agreements so that these can be accessible to clients who would like to know about your specific rules and boundaries. It would also allow clients to self-select clinicians whose policies best match their own beliefs and values. I think it would also be useful to other mental health professionals crafting their own policies to see a variety of practices related to different clinical perspectives and theoretical orientations.

Of course, I am still welcoming commentary on my own Social Media Policy which I know will evolve along with changes in the Internet. So if you have feedback, please share it via email or on Twitter.

Update: June 6, 2010

As of April, Facebook changed the “Become a Fan,” button to a “Like” button. While the terminology of the action of endorsing a page has changed, my beliefs about the problems inherent with clients “Liking” your business page on Facebook remain the same.

© 2010 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2010) I’m not a rock star! (More thoughts on Facebook fanning). Retrieved month/day/year from http://drkkolmes.com/2010/01/26/im-not-a-rock-star-more-thoughts-on-facebook-fanning/.

Please note that this is currently a work in progress. There may be important things to add to this policy, but this is my first draft. If you have any comments or suggestions or think something is missing, please directly email me.

Also, anyone is welcome to use or adapt this form to your own practice. I know that many practitioners adopt different stances than my own when it comes to how they manage clinical care and their social media policy. Please consider making your own policies readily available to your clients so that it is clear and documented, even if your approach is to take it case-by-case.

Friending

I do not accept friend requests from current or former clients. This holds true on Facebook and LinkedIn and all other social networking sites. My reasons for this stance are that I believe that adding clients as friends can compromise confidentiality and blur the boundaries of our therapeutic relationship. If you have questions about this, please feel free to bring it up in-session and I’m happy to talk more about it.

Fanning

I maintain a Facebook page for my professional practice. I do not allow clients to become fans of this page because I believe there is an even greater likelihood of compromised client privacy and I do not want others who may look through my fans to assume you are my client.

If you are my client and I see that you have become a fan of my Facebook page, you can expect me to delete you as a fan and bring it up in our session when I see you next.

Please note that you will always be able to view all my Page content without becoming a fan or you can subscribe to the page via RSS without creating a visible, public link to my Page.

Following

I currently keep a professional Twitter stream and a blog on my practice website. If you use an easily recognizable (to me) name and I notice that you’ve followed me on Twitter, you can expect me to bring it up in therapy so that we can briefly discuss it.

My primary concern will be how it relates to your own privacy. There are more private ways to follow me on Twitter (such as subscribing using an RSS feed) which would eliminate your having a public link to my content. But you are welcome to use your own discretion in choosing whether to follow me. There is nothing I post here that I would not want you to see.

Please be aware that I will not follow you back.

I do not follow current or former clients on blogs or Twitter. If there are things you wish to share with me from your online life, I strongly encourage you to bring them into our sessions where we can process them together, during the therapy hour.

Interacting

I do have a professional presence on Twitter, Facebook, and LinkedIn. I also keep a blog. You are always welcome to read my content on these sites if it is of interest to you. But please do not use these sites to send me messages or to interact with me outside of treatment. If you need to contact me between sessions, the best way is by phone. Email is second best, but only for quick, administrative issues such as changing appointment times. Please see the email section below for more information regarding email interactions.

Use of Search Engines

It is NOT a regular part of my practice to search for clients on Google or other search engines. Exceptions to this may be made during times of crisis. If I have a reason to suspect that you are in danger and you have not been in touch with me via our usual means (coming to appointments, phone, email) there may be a circumstance in which using a search engine to find another party close to you or seeing if you have or have posted to a blog, Facebook page, or Twitter may become necessary as part of checking on your welfare. These are extremely rare situations and If I ever resort to such means, I will definitely discuss this with you when we next meet.

Google Reader

I do not follow current or former clients on Google Reader. I also do not use this account to share articles with current or former clients. I share many links of interest via my Twitter account which you are welcome to read and I encourage you to bring your own items of interest into our sessions if there are things you want to share with me that you feel are relevant to your treatment.

Email

I prefer to use email only to arrange or modify appointments. Please do not use email to send content related to your therapy sessions, as email is not completely secure or confidential. If you choose to communicate with me by email, please be aware that all emails are retained in the logs of your and my internet service providers. While it is unlikely that someone will be looking at these logs, they are, in theory, available to be read by the system administrator(s) of the internet service provider. You should also know that any email I receive from you, and any responses that I send to you, will be printed out by me and kept in your treatment record.

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!