In 2009, I did a presentation at SXSW called Therapy 2.0: Mental Health for Geeks, even creating a corresponding wiki with resources. A month later, I spoke at the first Mental Health Camp for bloggers in Vancouver on the intersection of social media and mental health.

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

And it’s really not.

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

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

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

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

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

In addition to seeing clients in my private practice, doing research, and teaching, I am also the Digital Director for APA Division 42, Psychologists in Independent Practice.

We’ve just completed a Youtube video on the benefits of talking to a psychologist, and I’m pleased to share it here. Please do pass it along if you think it may help someone.

On Saturday, March 19, The New York Times published an Op-Ed I wrote on some of the concerns I have with consumer review sites when it comes to finding and rating mental health services. I appreciate those who took the time to kindly offer their comments on the piece both on the Times page and via email.

Those who only read the title The Wrong Kind of Talk Therapy or tag line (both written by the Times and not seen by me until the piece ran), may have gotten the false impression that I am against online reviews. I am not. But these sites do need a significant upgrade when it comes to reviewing health care services.

What struck me from the comments is the pain and frustration experienced by consumers of mental health care. Many expressed powerlessness and confusion when it comes both to finding good care and to understanding the process of psychotherapy. Such comments made it clear how important it is for mental health professionals to provide better information to demystify what it is that we do, how we work, and how we can help. It is also incumbent on mental health practitioners and organizations to let consumers know what they can do when they feel that something harmful has occurred in their treatment.

Most often, people simply struggle with a “poor match” when looking for a psychotherapist. It’s certainly hard to find someone who feels like the right fit. But when a clinician is impaired or is doing harm, licensing boards are a useful resource. Consumers can ask questions and make complaints to licensing boards. This is also the place to turn to when you want to verify that a clinician is licensed or if you want to see whether there are any disciplinary actions against a practicing professional. If you are seeking care anywhere, it is wise to choose a licensed professional partly because this means there is a governing body to turn to if something goes wrong.

In my office forms, I let my clients know that my presence on sites like Yelp is not a request for a testimonial, but I do remind them that they have the right to tell anyone about my services and how they feel about them whenever and wherever they wish. This right belongs to them.

For more on this topic, check out John Grohol’s Yelp and Therapist Reviews in which he makes some great points about the lack of reliability of the current rating sites and the problem of there being too many sites out there at this time for consumers to find meaningful data.

Last week, Psychology Today, the popular website that many psychotherapists use to advertise their practices, sent out an email to those with listings on the site to inform us that we had been opted-in to a new “security feature.”

From the email:

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

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

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

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

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

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

Update: 8/5/10

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

Hi Keely Kolmes,

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

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

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

FAQs:-

WHY AM I GETTING THIS CALL CONFIRMATION?

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

WHY DO I BENEFIT?

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

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

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

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

—
The folks at PsychologyToday.com
—

*Don’t reply to this email*

© 2010 Keely Kolmes, Psy.D.

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

I’m very pleased to announce that the National Coalition for Sexual Freedom has published an article I co-wrote with Geri Weitzman, Ph.D. on choosing a kink-aware therapist. You can find both the long article (16 pages) and a short FAQ on the Kink-Aware Professionals page. Here is a direct link to download the printable pdf of the 16 page white paper.

The NCSF is committed to creating a political, legal and social environment in the US that advances equal rights for consenting adults who engage in alternative sexual and relationship expressions. The NCSF aims to advance the rights of, and advocate for consenting adults in the BDSM-Leather-Fetish, Swing, and Polyamory Communities. They do this through direct services, education, advocacy, and outreach, in conjunction with their partners, to directly benefit these communities.

Read a snippet from NCSF’s press release below.

NCSF Publishes Important Information for Your Mental Health

NCSF and the NCSF Foundation are proud to announce two new and valuable publications: A Guide to Choosing a Kink-Aware Therapist, and the Therapists Guide to Polyamory.

A Guide to Choosing a Kink-Aware Therapist , created by Keely Kolmes Psy.D. and Geri Weitzman Ph.D., will help people who engage in BDSM find a therapist who can accept them without judgment or prejudice. Some therapists cause more harm than good when they slap a label of mental illness on a client simply because they enjoy kinky sex.

“Over the years, I have received many calls from folks around the globe who wanted access to therapy that was respectful of their kink identity, but didn’t know where to turn to find it,” says co-author Geri Weitzman, PhD. “We are excited to share this resource on finding kink-aware therapists with our community, in the belief that a warmly accepting therapeutic environment should be available to all.”

“Therapy needs to be a place where you can feel safe to bring your whole self. I hope that our article is a helpful tool for kink-identified clients and the therapists who want to learn more about working competently with them,” agrees co-author Keely Kolmes, Psy.D.

NCSF has also published second paper for therapists: A Therapist’s Guide to Polyamory. This resource can also be found on their site.

I have created a new page on my site which is a compilation of my blog posts geared towards consumers of psychotherapy. For Clients is a good place to start if you’re seeking more information about theoretical orientations, dual relationships, how therapy differs from advice-giving, and other information for therapy clients. I will keep that page updated for people who prefer to read just that information.

I have uploaded my Social Media Policy and have made some minor updates to my current Office Procedures and Agreement for Psychotherapy Services.

If you are a current client, I will update you on the changes and have you sign a new Acknowledgment of Notifications form to indicate that you are aware of these changes when we next meet.

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.

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/.

Update: March 31, 2010

Please note that since this original blog post, I have updated my Social Media Policy to include information about location-based check-ins and some other items not mentioned on this page. You are welcome to download the current document.

Other clinicians may copy, share, or adapt this policy to suit your own practice needs, but you may not use this work for commercial purposes. If you use my policy for training or educational purposes, please cite me as the original author.

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.

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

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/.