Dr. Keely Kolmes

Out of the Office

admin — Thu, 04 Mar 2010 04:30:57 +0000

Please note that I will be out of the office from Thursday, March 11th until Monday, March 22nd.

I will still be checking and returning phone messages and emails, but my response time may be delayed.

If you are experiencing a crisis, you should call 911 or go to your nearest Emergency Room.

Location Based Check-In Sites for Mental Health Professionals

admin — Fri, 26 Feb 2010 19:31:25 +0000

At a couple of recent trainings, and in consultations with other mental health professionals, the question has come up about whether is is okay to check in on sites like Foursquare, Loopt, brightkite, and Gowalla when one is involved in the provision of clinical services. I have met with a few clinicians in training who use these sites socially and who are eager to rack up points by checking in when they go to work at their practicum or internship sites to see clients. My predictably conservative take on this is that it is probably not the best idea.

It’s one thing for clients to decide on their own to add your clinic or private practice to these sites and, subsequently choose to check in when they attend therapy. But adding your own psychotherapy office or clinic to location-based social networking sites could be a walk down a slippery slope. It could be perceived as your encouraging clients to publicly check-in on these sites which raises a number of sticky issues.

When sites like foursquare encourage business owners to put their sites up to connect with their customers, they are usually thinking of bars, restaurants, or other non-confidential services. But when you put your own business on a site like this when you are involved in the provision of confidential services it’s a bit more dicey whether it’s simply strategic marketing and business promotion or an invitation for people to check-in. Given that ethics codes for psychologists, social workers, and marriage and family therapists all strictly prohibit the solicitation of client testimonials, might putting your psychotherapy practice on sites like this be perceived as a passive request for endorsement by clients? A trickier question is whether a “check-in” is the same thing as a testimonial. Maybe not, but it does seem to be some sort of indicator of patronage. We may not be realizing it, but our presence on these sites may be perceived as a veiled invitation for clients to disclose that they are in treatment with us.

I find myself wondering if particular populations or individuals are more likely to be lured by points and badges at the expense of their privacy. I can certainly imagine some adolescent clients going for the check-in before thinking twice. And if you work in outpatient treatment or see people multiple times a week, do you want them to become the Mayor of your clinic? We may hope that distressed clients have more on their minds than checking in when they go to therapy, but one never knows.

Some might point out that putting your practice up on a site does not mean that you have identified who you have seen in your office. This is correct, of course. A client still gets to choose whether or not to check in when they attend therapy and the disclosure is theirs to make. But the question remains whether the invitation alone could be perceived as subtly influencing some clients to do so.

These are questions about the gray areas of overlap between social networking and marketing of services. They stir up issues related to boundaries, ethics, confidentiality, and multiple roles. The APA Ethics Code applies only to activities that are a “part of (our) scientific, educational, or professional roles as psychologists.” The Internet has been already making it harder to distinguish the separation between our personal and professional lives. And certainly, once we have created a listing on sites to advertise our practices, we have brought our professional lives and the duties and responsibilities that come with it into another realm. It’s worth it to be mindful about which risks you want to take in your own professional practice.

Google Buzz Alarms a Psychotherapist

admin — Thu, 18 Feb 2010 07:17:09 +0000

Wake up and smell the smoke

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.

Warning bells

As I slowly woke up, it occurred to me that I should check my professional practice email account. Here is where the horror hit. I discovered that a handful of friends and family were following me, and so were a couple of clients. I also saw that I was also auto-following a client. As I looked through my list of followers, Gmail asked, did I want to follow them back? No! No! NO! NO! I did not. I did not want us linked at all. And why hadn’t I been asked or alerted before this morning, by the way?

At this point, it hadn’t even occurred to me that my public profile on Google which advertises my practice was also showing the lists of who was following me and who I was following back. Yes, this had already become public information on my profile.

Google Buzz and psychotherapy

This is problematic for a mental health professional for a number of reasons.

1. A number of my clients prefer email as their primary way of contacting me. If clients show up on my follow list (or I show up on theirs), that is a big breach of their privacy without any warning.

2. I deserve some privacy too. I don’t necessarily want clients or business contacts to know who else I regularly exchange email with, whether those people are clients, friends, or colleagues.

3. It was unclear whether people had chosen to manually add and follow me or whether Google had decided for them that they should be auto-following me. This bit of information can be of particular importance in the therapy relationship. Some may have assumed I followed them and were politely following me back. Some may have added me and felt rejected when I blocked them. Some may not have even known we were following one another in the first place. But since it was done automatically, without any prior notification, both parties in the relationship were left wondering but I still felt I had to act immediately to clean up the potential privacy mess.

I wasn’t the only person who was upset about this. I got emails from several other therapists who were distressed to find themselves following clients. Over the next couple of days, articles started to emerge that were addressing the privacy flaws.

I turned Buzz off immediately. But I then discovered that I had to go back in and manually block the folks I’d been following as well and remove the links to our names if I did not want them showing up on my public profile.

But this was a wake up call for me.

Confidentiality

My email signature for my private practice has always included a warning about the limitations of email in regard to privacy. Generally, clients do not send me emails about anything more than appointment confirmations or requests to reschedule. But sometimes, people choose email as the first point of contact in reaching out to me for my services. In these cases, I have found that they often share a lot more personal information. I had been well aware that gmail was not the most secure service, but I figured with the limited amount of emailing that I do with patients, it was a low risk endeavor. That was before Google decided to turn email into a social network. Obviously, the time has come for me to address this security problem in my professional practice.

My response has been to completely move my email to hushmail for all interactions with anyone with whom I have a confidential relationship. I have been pleased to discover that I can set up hushmail to forward new mail notifications to other email addresses without including the name of the sender in the alert. I have this setting selected so that client names are not being forwarded to other email accounts.Please note that as of this writing, there has been an apology from Google and a number of privacy updates to correct the Google Buzz problems. Here is Google’s official reply.

Steps for therapists

Still, if you are a therapist who has been unaware of the privacy issues related to Google Buzz, here are some steps you should consider taking:

1. Go into your Gmail settings and select “Disable Buzz.” You can also directly access this setting by selecting “Turn Off Buzz,” at the very bottom of your Gmail Inbox. (Click on photo for larger version.)

2. Let me be a warning to you. Now is the time to move your private practice email to a more secure service. Hushmail was my choice. But other options include ciphersend. Both sites also offer the option to put secure forms on your website, if you choose to do so. I recommend doing this for anyone who uses email as a way of communicating with clients, even if you’re not on gmail.

3. Remember that it is not enough to switch emails. Encourage your clients to delete your gmail address from their contact list and do the same for any clients with whom you have exchanged email in order to avoid future exposure or crossover on sites.

4. If you have mail from these sites forwarded to other email accounts, make sure you have opted not to have the email sender’s name included in the forward.

5. Update your web presence and advertisements to redirect to the new email address.

6. Be aware that if you use Google Reader, you may continue to get requests to share and follow items there.

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.

Five Dating Tips for Singles

admin — Mon, 15 Feb 2010 06:35:49 +0000

Last week, I spoke at a singles event for women. There is such a high emphasis in our culture on finding a partner that it can be hard to recognize what a rich opportunity being single can offer us. It is a chance to learn more about who you are and your wants and needs as you discover how you experience different dates and potential partners.

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

1. Know yourself

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

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

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

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

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

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

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

3. Learn to understand your dating plan or style

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

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

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

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

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

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

5. Check your responses

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

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

Change of Venue for Singles Event This Saturday

admin — Fri, 05 Feb 2010 04:24:06 +0000

Please note that the ThirtySomethings and Connexions event that I’ll be speaking at and facilitating this Saturday, February 6th has a new location.

It will now be taking place at Aquarium of the Bay @ Pier 39 – in the Farallon Room.

This event offers a fun, relaxed way for single women to connect and get to know one another. You may even learn a bit about yourself in dating and relationships. I’ll be offering dating tips for singles and facilitating small group activities.

Please come!

Saturday, February 6th, 2010

5:00 PM – 5:15 PM – Arrival
5:15 PM – 6:00 PM – Mingle Walk Through the Aquarium
6:00 PM – 6:30 PM – Welcome Activity with Roke Noir
6:30 PM – 8:30 PM – Interactive Discussion and break out groups with Keely Kolmes, Psy.D. and Roke Noir
8:30 PM – Break
9:00 PM – Singles Party & Dance with Finding Stella Band
Hard Rock Café @ Pier 39

You can find out more details and still get tickets on Betty’s page.

I hope to see you there.

Updated Private Practice Social Media Policy

admin — Mon, 01 Feb 2010 12:07:28 +0000

Thanks to everyone who provided feedback on my first draft. I have slightly modified some sections and added a bit more to this document. I realized that some sections needed a bit more explanation so that clients would understand my rationale for my practice choices. When this policy is final, I will upload it to my forms page and print it up for current clients. As before, I invite anyone to copy or modify this form for their own practice.

This document outlines my office policies related to use of social media. Please read to understand how I conduct myself on the Internet and how you can expect me to respond to various requests and interactions between us.

If a time should come when I revise any of these policies, I will bring an updated copy of this form to our session so that you are aware of any changes.

If you have any questions about anything within this document, I encourage you to bring them up when we meet.

Friending

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

Fanning

I maintain a Facebook Page for my professional practice. I use this Page to allow colleagues to share my blog postings and practice updates within Facebook. All of these articles are also directly available on my website.

While you are always welcome to visit my Facebook Page and read or share articles posted there, I do not allow clients to become Fans of this Page. I believe having clients as Fans of this Page creates an even greater likelihood of compromised client privacy and I do not want others who may look through my list of Fans to find any clients listed. In addition, it is a violation of my professional ethics code to solicit testimonials from clients. I feel that the term “Fan” implies a request for a public endorsement of my practice.

If you are my client and I see that you have become a Fan of my Facebook Page, you can expect me to discuss this with you in-session and request that you remove yourself from my Page. If it will be awhile before our next scheduled meeting, I may remove you myself and I will discuss it with you during our next session.

Please note that you can subscribe to the page via RSS without becoming a Fan and without creating a visible, public link to my Page. You are welcome to do this.

Following

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

My primary concern will be your privacy. There are more private ways to follow me on Twitter (such as subscribing using an RSS feed or using a locked Twitter list), 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 note 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

Please do not use messaging on websites such as Twitter, Facebook, and LinkedIn to contact me. These sites are not secure and I may not read these messages in a timely fashion. If you need to contact me between sessions, the best way to do so is by phone. Direct email at drkkolmes [at] gmail is second best 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. Extremely rare 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, or email) there may be a circumstance in which using a search engine (to find you, find someone close to you, or to check on your status) becomes necessary as part of ensuring your welfare. These are extremely rare situations and if I resort to such means, I will document it and discuss it 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. If there are things you want to share with me that you feel are relevant to your treatment, I encourage you to bring these items of interest into our sessions.

Business Review Sites

There are a number of different websites including Yelp and Healthgrades, on which you may find my practice information. Many of these sites comb search engines for business listings and automatically add listings. If you should find my listing on these sites, please know that my listing on any of these sites is NOT a request for a testimonial or endorsement from you as my client.

The American Psychological Association’s Ethics Code states under Principle 5.05 that it is unethical for psychologists to solicit testimonials: “Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.”

Of course, you have a right to express yourself on any site you wish, but due to confidentiality, I cannot respond to any review on any of these sites whether it is positive or negative. I urge you to take your own privacy as seriously as I take my commitment of confidentiality to you.

If we are working together, it is my hope that you will bring your feelings and reactions to our work directly into the therapy process. This can be an important part of therapy, even if you decide we are not a good fit. If you still choose to write something on a business review site, then please remember this is a public forum on which you could be sharing personally revealing information. I urge you to create a pseudonym that is not linked to your regular email address or friend networks.

Lastly, none of this means that you cannot share that you are in therapy with me wherever and with whomever you like. Confidentiality means that I cannot tell people that you are my client and my ethics code prohibits me from requesting testimonials. But you are more than welcome to tell anyone you wish that I’m your therapist in any forum of your choosing.

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.

Upcoming San Francisco Event for Single Bisexual and Lesbian Women | February 6th!

admin — Thu, 28 Jan 2010 05:38:08 +0000

I will be joining Betty Sullivan and Roke Noir on Saturday, February 6th for ThirtySomethings and Connexions for Singles.

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

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

Please join us!

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

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

The program includes:

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

- Break & Reset: 8:30 PM – 9:00 PM

- Singles Dance with Live Performance by Finding Stella: 9:00 PM – 11:00 PM

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

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

More details to come!

I’m Not a Rock Star! (More Thoughts on Facebook Fanning)

admin — Tue, 26 Jan 2010 12:00:05 +0000

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 HealthGrades.

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, privilege is also held by clients and they can choose to reveal they are in therapy with me whenever and to whomever they choose. Still, this does not give me permission to solicit client endorsements or to violate client confidentiality. I am also a grown-up running a clinical practice, and as such, I also have a right 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 see.They can still view 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 fuzzies 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.

Private Practice Social Media Policy for Psychotherapists

admin — Mon, 25 Jan 2010 18:55:01 +0000

I have been working on my Social Media Policy for my private practice. This will eventually be available as a download on my Forms page and I will also distribute it to current clients.

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.

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.

On the Difference Between Therapy and Giving Advice

admin — Wed, 20 Jan 2010 03:05:25 +0000

“But what should I do?”

It doesn’t happen often, but once in awhile, I will meet with a client who asks me some variation of the above. The thing that is most challenging (to me) about clients who directly ask what they should do is that they are usually those who are experiencing the most pain and confusion. It makes sense that people who are struggling, hurting, or experiencing despair would want someone to tell them what to do to make it stop. And, often, I would like to help them make it stop too, so there is a strong pull to give an answer.

But giving advice is not psychotherapy. Therapy is a place to explore your feelings and learn about yourself. It’s a place of self-discovery. It’s a place to find out how you have become tangled up and a place to learn how to untangle yourself. It’s a place to gain a better understanding of your inner world and your relationships. This process is what people come into therapy to learn. It’s what mental health professionals go to school to learn how to provide. Sometimes it takes time and reflection to see the patterns and it isn’t a quick fix, as much as both therapist and client sometimes wish it were. Sometimes just acknowledging and sitting with that pain, confusion, and wish for an immediate answer is the best thing we can do.

This does not mean that I withhold information from clients when I think it might be helpful. If I notice a theme or have some concern that a client may not be acting in their best interest, I speak up. It also doesn’t mean that I am non-directive. There are times when I get very directive with clients. I integrate cognitive-behavioral interventions in my work and I tend to use them when people need symptomatic relief or when people are trying to break habits. At the most extreme that can happen when someone is in danger and I need to get them into the hospital or go over a safety plan with them. In these cases, we may make a list of people to call and things to do when they are feeling actively suicidal.

Less extreme versions of my being directive may include encouraging a client to make an appointment with a psychiatrist. Or I may develop a plan for a client to do breathing or relaxation exercises when she or he is anxious or call a friend to go to the gym when depressed. With my couples, I often prescribe “homework,” which includes communication exercises or plans to notice positive aspects of one another or the relationship. In my dissertation support group, I will sometimes make suggestions to counteract procrastination.

But these are specific treatment approaches to specific problems and not the same thing as telling a client what to do with major life decisions. If you want a therapist to tell you what to do, as opposed to helping you figure out what is right for you, it could be worth thinking twice about what you’re seeking. Some people want others to tell them what to do because it means not having to take responsibility if things don’t work out. Friends and counselors can give you advice. But if what you are looking for is just someone to give advice or tell you the things that have worked for them, it may not be psychotherapy that you’re looking for. Conversely, if you are going to therapy and you find that your therapist fills the time with advice, suggestions, or anecdotes about their life, it could indicate that they have some discomfort with allowing the therapeutic process to unfold. Be aware that you can find someone else who creates the space for your process of becoming conscious and finding the answers that are right for you.