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.

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/.

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

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

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

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

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

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

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

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

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

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

Update: June 6, 2010

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

© 2010 Keely Kolmes, Psy.D.

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

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

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

Friending

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

Fanning

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

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

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

Following

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

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

Please be aware that I will not follow you back.

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

Interacting

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

Use of Search Engines

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

Google Reader

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

Email

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

One post by Heidi N. Moore, Facebook to Privacy: Drop Dead, accurately referred to it as a “bait and switch,” and addressed why reporters may wish to keep their friend lists private. Joseph Bonneau, a security researcher, wrote Facebook Tosses Graph Privacy Into the Bin, about why friend lists should be regarded as sensitive data. And then there is Kevin Bankston of EFF’s post Facebook’s New Privacy Changes: The Good, The Bad, and The Ugly.

Since the initial changes were made, Facebook has added back the ability to hide your friend list from other users. Nevertheless, in some of my exchanges with other mental health professionals, the option of blocking users has come up more than once as a means of ensuring greater privacy. Before last night, I had never tried using the Block feature on Facebook, as the original privacy settings had met my needs well. I experimented with it yesterday and it does seem to be a useful way to restrict access to one’s profile and I can see some benefits to using it in certain situations.

That said, I have some strong objections to relying upon the Block feature as a means of restricting access to profiles, particularly when health care providers use it to Block patients.

Does it work?

My first concern is technical: blocking particular email addresses assumes that you know which email address a person is using to access their Facebook profile. Many users link multiple email addresses to their Facebook accounts, so blocking the email address you know does not completely ensure that someone doesn’t have access to you. It also doesn’t address users who have used one email address to contact you but have their mail forwarded to another address. These users may still be able to view your profile when using an email address with which you are not familiar.

More privacy infringement

My second issue is related to overall privacy violations: forcing users to choose the Block feature as the only way to restrict others’ access to their profile is simply another means of collecting data. Typing names into a Block list is one more infringement on personal privacy. When we do this, we are providing specific information to Facebook about people and saying something about our connections to them. This is much more information than I care to provide to Facebook when there is a much easier way to restrict access that does not entail my providing the company with information about my specific relationships.

Our own commitment to client privacy

Just as we expect Facebook to honor our privacy, our clients expect us to do the same. As an issue of professional ethics, it seems to me to be a violation of patient privacy to enter client names and/or email addresses into Facebook unless that is specifically indicated in our treatment contracts.

My current treatment agreement states that I keep patient information private and do not share it with others unless there is reason to believe that the patient or another individual is at risk. My policy does not indicate that I may also share client information with Facebook. It is easy to forget that when we type names into a search engine or a field on a social network, we are also sharing information with others. Doing so without, at the very least, informing our clients seems to be a breach of trust.

However, if Facebook continues to make it impossible for us to restrict profiles to users of our choosing, those of us who wish to continue using the social network in our private lives may find Block to be a useful feature. If I ever decide to employ it on my own Facebook profile, I will include a statement about this in my Social Media Policy, so that clients are aware that I do this and why. Clinicians who are already Blocking clients may wish to consider explaining that they do it not only to prevent clients from stumbling onto their interactions with others, but also to prevent therapists themselves from seeing their clients’ personal interactions with shared friends if they should have overlapping social circles.

That said, I’d greatly prefer that Facebook just do the right thing and allow their users to have back the greater control over profile privacy that they enjoyed up until just a few days ago.

References

Bankston, K. (2009, December 9) Facebook’s New Privacy Changes: The Good, The Bad, and The Ugly. Retrieved December 11, 2009 from http://www.eff.org/deeplinks/2009/12/facebooks-new-privacy-changes-good-bad-and-ugly

Bonneau, J. (2009, December 11) Facebook tosses graph privacy into the bin. Retrieved December 11, 2009 from http://www.lightbluetouchpaper.org/2009/12/11/facebook-tosses-graph-privacy-into-the-bin/

Kolmes, K. (2009, December 10) How Facebook is Getting it Wrong: New Privacy Settings Offer Less Privacy. Retrieved December 11, 2009 from http://drkkolmes.com/2009/12/10/how-facebook-is-getting-it-wrong-new-privacy-settings-offer-less-privacy/

Kolmes, K. (2010, February 1) Private Practice Social Media Policy. Retrieved April 26 2010) from http://www.drkkolmes.com/docs/socmed.pdf

Moore, H. (2009, December 10) Facebook to Privacy: Drop Dead. Retrieved December 10, 2009 from http://www.thebigmoney.com/blogs/sausage/2009/12/10/facebook-privacy-drop-dead

Muller, A.Y. (2009, December 9) Updates on Your New Privacy Tools. Retrieved December 11, 2009 from http://blog.facebook.com/blog.php?post=197943902130

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) Should mental health professionals block clients on Facebook? Retrieved month/day/year from http://drkkolmes.com/2009/12/11/should-mental-health-professionals-block-clients-on-facebook/.

So let’s think this through. First, on the surface, it can seem that LinkedIn might be a reasonable space on which to accept requests from clients. Afterall, it is a professional context, so it’s not as potentially confusing as adding a client on a network that is used primarily for sharing personal photos or tidbits. We are in our professional role on this site. On the other hand, it can blur the boundaries of the clinical relationship. It also creates a visible and public connection to someone with whom we are supposed to be in a confidential relationship. Two of our primary commitments to clients are providing confidentiality and avoiding multiple relationships that could cause harm (APA, 2002).

Some would say that simply listing someone as your contact doesn’t compromise confidentiality in and of itself or create multiple roles.

But consider the following scenario:

Your former client, Linda, sends you a request to connect on LinkedIn which you decide to accept. You rarely go onto the site, so you don’t really think about it much until four months later, when Linda sends you a message requesting that you make an Introduction to your friend, Tom, who she sees in her LinkedIn network. Linda is looking for a job at Company X and she sees that Tom, your 1st degree contact, works there.

What should you do? Ignore Linda’s request? Make the introduction? What if Tom wants to know how you know Linda? Even if Linda says it’s okay, this does not mean it’s okay to reveal that she was in treatment with you.

What if you refuse Linda’s request? Do you want to call her and discuss this? Reply via email?

What if Linda asks you to write a recommendation for her on the site? What if instead of Linda making the request, one of your other business contacts asks you to make an introduction to Linda? What if his interest is more personal and he just wants to ask her out? What if his interest is specifically about business? Would you do that? Would you be comfortable asking Linda to help your friend get a job at her company?

While a scenario like this may seem unlikely, it’s easy to see how quickly an innocent click of the mouse can turn what was once a therapy relationship into something more complex. It’s trickier too, when requests are made by former clients, since we are not typically in the position of being able to explain to them why we decline a request, if we do so. And, obviously, our commitment of confidentiality extends beyond the termination of the therapy relationship.

It’s good to remember that the purpose of LinkedIn is to engage in business networking. Most therapists do not include making job introductions as part of their practice with clients. If you are someone who would not typically do this in your offline practice, then adding a client on this site is unwise. Some clinicians, however, feel strongly that having across-the-board policies is at odds with how they work. Some may feel more comfortable deciding who to add on a case-by-case basis, and there may be scenarios in which it could be argued that making the connection serves the clinical work in some way.

What do I recommend? While I appreciate the thoughtfulness and care that can go into making decisions on a case-by-case basis, doing this also opens the door to risk in terms of professional liability and the possibility of damaging therapeutic relationships. Suppose a former client experiences feelings of rejection when you decline her contact request, but she then discovers that you went ahead and accepted her friend’s request? This is why having a clear policy about how you handle contact requests and communicating this to your clients (via Social Media Policies and Consent to Treatment forms) is important. My own policy is not to add current or former clients as contacts on any social media site.

Some last considerations for psychotherapists using LinkedIn are issues related to your privacy. There are a number of settings that you can adjust on the site, including whether you wish make your list of contacts available to all connections who are browsing your profile or to no one. If this is information you’d like to keep private, you go to the Settings on your profile, go to Privacy Settings, and select Connections Browse. Here you have the option of hiding or showing your connections list.

Another privacy setting that you may adjust is whether people can see if you’ve browsed their profiles. You change this setting under Privacy Settings > Profile Views, where you may choose whether to show your name, just your industry and title, or to remain completely anonymous. Lastly, under Profile > Profile Settings, you can to go Public Profile to choose whether or not to let your profile show up on search engines. Be aware that many aggregator sites can link your business profile to your social profiles on other social networking sites, merging your online identities, based upon matching the people in your friend network. If you maintain a pseudonym for your personal life, you might prefer to keep these identities dissociated by keeping your business network off of search engines.

References

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) LinkedIn for mental health professionals. Retrieved month/day/year from http://drkkolmes.com/2009/11/16/linkedin-for-mental-health-professionals/.

I will be joined by James Lyda, Ph.D., Staff Psychologist at the Tang Center at UC Berkeley, who will present a morning segment on research on Facebook and on college students’ usage of social networking sites. I’m very excited about this training and about hearing about the clinical issues that Training Directors and interns are encountering.

The outline and schedule are below:

Northern California Training Directors Conference

Clinical and Ethical Issues Related to Social Networking and College Mental Health

October 23, 2009

9:00am – 3:00pm

This training focuses on Web 2.0 social networking and its relevance to college mental health. Clinicians will learn how students are using the Internet and what related issues they may be bringing into treatment. We will also cover clinicians’ personal and professional online presence and how this may intersect with their clinical role. We will also discuss related clinical, legal, and ethical issues as they come up in social networking and  college mental health.

II. The Google Factor

II. Research on College Students’ Usage of Social Networking Sites

III. Facebook, Friending, and Privacy Settings

BREAK

IV.  Overview of Twitter, Flickr, MySpace, FriendFeed, Foursquare, LinkedIn and other sites

V. Blogging, RSS feeds, and personal ads

VI.  Clinical, Legal and Ethical Issues as they relate to the Internet and social networking

VII. Discussion

LUNCH

VIII. Small Group Breakouts with Clinical Vignettes

IX. Larger discussion of Vignettes

X. Completion of Paperwork and Surveys

]]> http://drkkolmes.com/2009/10/18/my-continuing-education-training-clinical-and-ethical-issues-related-to-social-networking-and-college-mental-health/feed/ 1 http://drkkolmes.com/2009/08/28/still-time-to-vote-on-sxsw-2010-panel-from-freud-to-facebook/ http://drkkolmes.com/2009/08/28/still-time-to-vote-on-sxsw-2010-panel-from-freud-to-facebook/#comments Fri, 28 Aug 2009 15:00:15 +0000 admin http://drkkolmes.com/?p=1036 The PanelPicker doesn’t close until the end of the day next Friday, September 4th. So if you like the panel I’m co-proposing with Dr. John Grohol, and you haven’t yet voted, please do. We are working on adding some great speakers who are working within technology and psychology. And please know that comments and questions are also encouraged on the PanelPicker page.

Psychology and the Internet: From Freud to Facebook

With the popularity of online social networks and services, what’s the psychology behind how people use them? How is the Internet changing people’s lives for better (or worse)? What does the research show about how people use Facebook and Twitter? Can you get effective mental health treatment online?
Our panel will address the following questions:

1. What is research telling us about technology and mental health?
2. How are Facebook and Twitter changing our relationships with others?
3. How is technology being used to help people with mental health concerns?
4. Is e-therapy a viable alternative to face-to-face treatment?
5. Are people’s online identities merging with their real life ones, and if so, what are the ramifications of this?
6. Is technology creating new types of psychological or personality challenges?
7. How do online support groups work and are they effective?
8. What computer software programs are most helpful for which issues?
9. Is Internet addiction something to be concerned about and if so, what do you do about it?
10. What clinical and ethical issues arise when combining mental health with technology?

You can vote for our panel (and others you’re excited about seeing at SXSW 2010, including music and film panels) by heading over to the PanelPicker.

Dr. Grohol and I met at SXSW 2009 where we attended one another’s Core Conversations, both of which focused on mental health and technology. Mine was Therapy 2.0: Mental Health for Geeks, which also included a resource wiki for attendees and those who couldn’t make it to the presentation. His was Social Networking in Health: e-patients, Data, and Privacy. Both Core Conversations generated significant interest which delighted me, as I don’t typically see many health related panels at SXSW.  I was also happy to connect with another psychologist who is passionate about the relationship between psychology and social media. As you can imagine, I’m thrilled that we will be collaborating for next year’s conference, should our panel be selected.

Last year’s Core Conversation was designed as an interactive discussion with all those in the room. But this year, I’m interested in doing a more formal presentation compiling research on technology, social media, and mental health and presenting it to SXSW attendees. Here is our submission:

Psychology and the Internet: From Freud to Facebook

With the popularity of online social networks and services, what’s the psychology behind how people use them? How is the Internet changing people’s lives for better (or worse)? What does the research show about how people use Facebook and Twitter? Can you get effective mental health treatment online?

2. How are Facebook and Twitter changing our relationships with others?

4. Is e-therapy a viable alternative to face-to-face treatment?

5. Are people’s online identities merging with their real life ones, and if so, what are the ramifications of this?

6. Is technology creating new types of psychological or personality challenges?

7. How do online support groups work and are they effective?

9. Is Internet addiction something to be concerned about and if so, what do you do about it?

10. What clinical and ethical issues arise when combining mental health with technology?

We are hoping to be able to include a couple of other panelists who are involved in psychology and social media.

The PanelPicker will remain open through the end of the day on Friday, September 4th, so don’t forget to vote for the presentations that you want to see. And I hope to see you again in Austin next year.

While I had been using Twitter socially since 2006, it hadn’t occurred to me to create a professional Twitter presence until just this year. In just a few months, I have been able to connect and engage with so many people around the psychology issues I’m most passionate about. It’s been an incredible resource for me and has allowed me to have so many interesting conversations and collaborations with people. In fact, I get so much out of it myself, that it’s very easy to forget that others find value in what I post.

If you’re a mental health professional who is interested in using Twitter, you may want to read my post Managing Twitter as a Mental Health Professional. Plenty of us are already there having conversations about mental health issues and we would love to connect with you.

Speaking of the others who are already connected on Twitter, I am especially delighted to be in such great company with the other top ten. If you’re interested in psychology tweets, you should definitely be following these folks too. Links to them are here and here.