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

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

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

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

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

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

References

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

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

© 2010 Keely Kolmes, Psy.D.

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

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.

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.

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

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

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

Initial Contact

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

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

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

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

Software Security

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

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

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

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

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

Hardware Security

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

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

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

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

Social Networking Sites

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

Shared Email Lists

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

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

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

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

Policies

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

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

Non-Confidential Exchanges

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

References

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

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

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

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

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

© 2010 Keely Kolmes, Psy.D.

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

Please join our group: Bay Area Therapists Affirming of Diversity in Sexuality

This is a free group for mental health professionals in the Bay Area of California. We offer support, networking, and consultation for Bay Area clinicians and mental health trainees who embrace the full range of sexual expression of consenting adults. Our respective practices explicitly welcome and serve clients who engage in alternative sexual behaviors and relationships, including kink and poly folks.

We offer an email list and meet every other month at a member’s office.

We are especially interested in reaching out to students who may not have mentors or support in their clinical programs around working with sexually diverse populations.  Most clinical programs encourage students to explore their cultural identities and offer student groups organized around ethnicity, religion, LGBT-identity, disability, or other cultural affiliations.

But students who are kink or poly-identified or who want to work with these populations may have a more difficult time identifying one another and forming such groups. Many schools still don’t recognize these alternative identities as deserving of non-biased care and respect. We are seeking to bridge this gap. We offer a safe space to connect with other mental health professionals who are affirming of the full range of diverse sexual expression.

Contact me at drkkolmes at hushmail dot com if you would like to get connected with us.

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

SFCP Community Members’ Professional Development Salon

The Web 2.0 Psychotherapist: The Therapeutic Relationship and Social Media

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

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

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

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

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

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

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

1.5 CME/CE credits (pending) for $15.00

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

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

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

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

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

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

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

Commercial Support: None

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

Results of our survey will be posted on this blog by August 30th, 2010.

Please check back then.

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.

© 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/.

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.