I’m happy to report that our slides are up summarizing the data Dan Taube and I collected on clients encountering their psychotherapist’s information on the Internet.

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.

I’m so very pleased and excited to announce the launch of Without My Consent, a project on which I sit on the Advisory Board with a fine group of Internet superheroes. This project was co-founded by Erica Johnstone and Colette Vogele.

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.

I am home after presenting for a second time at SXSW Interactive this week. This year, SXSW included a Health track which was a great addition to their programming, and of course, it made my annual trek even more meaningful. I was delighted to be able to attend more health panels this year and to meet up with more psychologists this year (in addition to long-time attendee, John Grohol, Psy.D., who has been my sole SXSW mental health pal for the past three years).

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

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

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

Susan Spaight posted a lovely summary of our presentation.

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

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

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

The website OnGoodAuthority is featuring a new CE course called Facebook and Google and Twitter…Oh My! Ethical Issues for Clinicians.

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:

Therapist-Client Interactions on the Internet

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.

Facebook has released a new Location feature that already has critics — including the ACLU — worried about privacy concerns. As someone with a Facebook account, I found myself once again wondering why it was that I was hearing of new features on Facebook from news sources, rather than being notified of them when logging into my account. If you care about your privacy or you work with co-workers or clinical populations who have privacy worries, you may want to be aware of the new information that may be shared.

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.

This article is part of an online course: Digital and Social Media Ethics for Psychotherapists for 8 CE credits

Media psychology

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

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

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

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

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

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

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

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

Establishing a professional relationship

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

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

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

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

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

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

Responding to Interview and Guest Writing Requests

Getting your point across

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

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

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

Maintaining confidentiality and obtaining informed consent

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

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

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

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

Providing commentary on public figures or news items

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

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

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

Other issues related to client rights and dignity

Whose status update is this anyway?

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

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

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

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

Conclusion

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

References

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

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

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

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

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

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

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

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

© 2010 Keely Kolmes, Psy.D.

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

Last February, the Google Buzz fiasco affected lots of people who did not want their email relationships exposed to the world. At the time, Dr. Kathleen Young and I shot a bunch of emails back and forth sharing our concerns over the situation. Dr. Young, who also maintains a professional Twitter account pointed out to me how Google Searches were showing people’s other connections through Google, Facebook, and Twitter. Google’s Social Search is currently in Beta and is a way that Google is creating a network of connections to identify relevant social search results.

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

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

So I Googled myself!

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

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

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

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

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

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

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

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

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

© 2010 Keely Kolmes, Psy.D.

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

I have been getting frequent requests for certain archived blog posts on Social Media for therapists. As a result, I’ve decided to compile them on a separate page. I will continue to blog here, but I am launching a new page: For Clinicians Using Social Media on which I will summarize all of the posts for mental health professionals as separate chapters. This page will always be accessible from the top of my main blog page.

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

The experiment

Last May, I decided to play around with Facebook ads, and as part of that, I created a Facebook Page for my private practice. It was an experiment and I posted as much on Twitter at the time, expressing some ambivalence and saying that I wasn’t sure if I would keep it up. I asked a few friends to help me beta test it, and over time some colleagues, students, and other folks have become Fans.

I always had some trouble with the term “Fans,” and I’ve blogged a bit about that here and discussed it in my Social Media Policy.

It occurred to me sometime in the past couple of weeks that it’s been ten months and it was time to re-evaluate. I think I’ve gathered enough data to determine that a Facebook Fan Page does not feel right for me or my practice.

My issues with the Page

I have always had mixed feelings about the Facebook Page because I worried that that it might invite clients to Fan me which could complicate the clinical relationship around boundaries and confidentiality. I also worried that it potentially exposed my personal life (friends, colleagues, and family who were Fans). I worried that if there were negative fallout, I’d feel that it had been my own doing (or undoing, as it were).

At the same time, as someone who writes about Social Media, I also wanted to carefully explore it to see if it was useful in any way.

Astute readers may have noticed that I’ve never placed a link on my website’s Contact sidebar to the Facebook Page (unlike with Twitter), primarily because I wanted the Page to bring people from Facebook to my website and not the reverse.

My experience

I haven’t encountered a single negative clinical experience with the Page since creating it. I’m pleased about this and think I’m fortunate to be able to quit while I’m ahead!

The worst that has happened is that some colleagues have questioned the wisdom of having such a Page, noting the mixed signals of having a Page that says “Become a Fan,” while limiting who can actually become a Fan.

I will never know what clients choose to keep unmentioned, but I will say that I have yet to have a client bring up my Facebook Page in a therapy session.

I also have never had a client become a Fan.

It’s certainly possible that some of the Fans of the page who I don’t recognize are clients who created a pseudonym to follow me, but I think that is highly unlikely.

Why delete it?

Ultimately, I continue to have mixed feelings about the Facebook Page.

I’m finding it to be more a source of worry than I’d like. I’m not convinced the Facebook Page adds any real value to my practice or my life from a marketing perspective or an engagement perspective. I’m also not sure that I’m offering anything new or novel on that site. Most of my professional conversations happen on Twitter, email, or on other forums for mental health professionals.

In addition, I’m not passionate about it. My energy is more invested in blogging on my own site, guest blogging, and posting on Twitter and other professional forums for therapists which reside on Ning or LinkedIn.

I engage with people on Twitter, but those conversations don’t happen directly on a page that I’m hosting, and hence and I feel more free to dip into the conversation when it moves me. With the Facebook Page, I’ve felt more responsibility to monitor who becomes a Fan or what’s written on my Wall to be sure I feel okay about everything posted there, and I find that a poor use of my time.

Thank you

I want to thank all the friends, colleagues, and supporters who helped me explore the Facebook Page in the first place and I want to remind you that if you do want to follow my blog postings or Tweets, you can always do so on my website or Twitter.

A planned termination

I plan to delete some posts over the next weeks and to delete the Facebook page entirely by the end of April, so you can all consider this a planned termination.

And if you are deeply sad about the deletion of my Page, then maybe we really do need to talk.