Earlier this week, a colleague brought my attention to a contest that was being run on Goodtherapy.org. The contest invited participants to compete for six months of free weekly therapy sessions with the therapist of their choice. Participants entered the contest by posting a public comment sharing the following information:

• What are the obstacles currently preventing you from being able to receive or afford therapy?
• Why do you want to go to therapy and what issues are you facing or problems are you experiencing?
• How would you like to benefit from therapy and what are you hoping to achieve?

Top entries were going to be chosen and then the winners would be selected by having readers vote on the one most deserving of the prize of free therapy. While I appreciate that many people find it empowering to use Internet forums to write about the issues they struggle with, having such comments used as a way vie for the prize of “most worthy” of psychological care, as voted by readers, was objectionable in a number of ways.

A number of mental health professionals, including DeeAnna Merz Nagel and others who focus on clinical ethics,  posted comments expressing concern that this contest was exploitative of vulnerable populations and would violate many clinical ethics codes. The initial response from the website was to say that as a referral service, they were exempt from having to adhere to ethics codes. They also noted that names and emails were anonymous in the blog comments, offering participants a layer of protection.

Nevertheless, a couple more comments were posted by concerned practitioners, including myself, stating that we thought the contest was not offering appropriate protection to vulnerable people and that having readers vote on who was worthy of the grand prize was, at the very least, in poor taste.

After just a few days of commentary, Goodtherapy.org responded by removing the public comments (entries) from the blog and deciding not to allow users to vote on stories to pick the winner. Winners will now be selected by GoodTherapy.org.

I am grateful to those who spoke up and left comments expressing opposition to the format of the contest. But I especially wish to commend GoodTherapy.org for their thoughtfulness and care in reflecting upon the objections raised. They demonstrated sensitivity and flexibility in revising the competition so that it does not expose people who are in great need.

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

We will soon be writing up our findings to submit for publication, but I’m pleased to be able to share this data with all of the folks who participated in our research and those who helped us reach out to potential participants. We could not have done this without the magic of social media and all of your help!

I’m very appreciative and I hope that our findings help bring greater awareness and understanding to how the Internet and social media are impacting the psychotherapy relationship.

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

Without My Consent is intended to provide resources and information to victims of online harassment to help them find safety, seek justice, and stand up for their rights. We also hope to provide psychological resources for people who have been harmed.

It is also our hope that our site serves as a deterrent to those who may be thinking of doing harm to another individual. These individuals may wish to seek help to process the intense or disturbing feelings that might lead them to want to lash out against another person in such a way.

This project was recently mentioned on June 2, 2011 in The New York Times story How to Unmask the Internet’s Vilest Characters. This article discussed one of Without My Consent’s strategies: encouraging victims to file suit pseudonymously.

Keep your eye on us. There will be some interesting news and updates coming soon.

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

I’m pleased to be one of the contributors to this course.

This 3 unit CE course presents four audio interviews by Barbara Alexander, LCSW, BCD with the following speakers:

• Curt Kearney, MA, LCPC – “My Patient Wants to ‘Friend’ Me”
• Keely Kolmes, Psy.D.  – “A Social Media Policy for Your Practice”
• Lisa Johnson, Ph.D. – “Social Media Enhances Clinical Work”
• Frederick Reamer, Ph.D. – “Standards for Using the Internet and Social Media”

There is currently a pre-order special: $35 until January 15, 2011.

After that, the price will go up to $55.

Currently, you must order this by phone: 800-835-9636.

For those who do not wish to take the CE but who still want to listen to the interview, I will upload my segment here in the near future.

Listen to a brief clip of this interview:

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

Those who want control over Locations should take the following steps.

1. Log into your Facebook account and in the upper right hand corner where it shows Account, click on that and drag down to Privacy Settings.

2. Here you will see what you are sharing on Facebook. Check to see what is selected for Places I Check In which may be set up as “Everyone,” Friends of Friends,” or “Friends Only.”

(Clicking on all images will let you view them in large size.)

3. If you want to modify the setting, click on Customize Settings at the bottom.

4. This will bring you to the following screen.

5. If you want the greatest level of privacy, you would make sure three things are selected here:

First, make sure “Only Me” is selected for “Places I Check In.”

Second, Disable “Include me in People Here Now” after I check in. Enabling this will allow others to see if you are at the venue (feel free to click the “See an example” link on Facebook to see what this will look like to anyone else checking in).

Third, at the bottom, make sure “Friends can check me into Places” is Disabled.

You can read more about the new feature and the concerns of others on mashable and also on Violet Blue’s blog in which she publicized the potential problem raised by @RodBegbie about what happens when someone adds your home address as a venue on Facebook. It sounds as though users will have to go through a tedious process of flagging a venue and then waiting for Facebook to respond in order to get their personal information removed.

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

From the email:

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

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

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

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

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

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

Update: 8/5/10

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

Hi Keely Kolmes,

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

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

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

FAQs:-

WHY AM I GETTING THIS CALL CONFIRMATION?

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

WHY DO I BENEFIT?

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

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

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

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

—
The folks at PsychologyToday.com
—

*Don’t reply to this email*

© 2010 Keely Kolmes, Psy.D.

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

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

Media psychology

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

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

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

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

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

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

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

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

Establishing a professional relationship

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

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

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

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

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

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

Responding to Interview and Guest Writing Requests

Getting your point across

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

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

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

Maintaining confidentiality and obtaining informed consent

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

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

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

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

Providing commentary on public figures or news items

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

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

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

Other issues related to client rights and dignity

Whose status update is this anyway?

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

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

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

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

Conclusion

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

References

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

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

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

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

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

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

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

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

© 2010 Keely Kolmes, Psy.D.

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

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

Email Tips for Clinicians

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/.

Facebook released news of some big privacy changes this week. As always, changes that affect our privacy settings are important to  fully understand. The biggest changes allow third-party websites to access and store information about individual users. You can find out more information here along with some instructions on how to restrict information. Just to be clear, if you’re someone who uses a number of Apps that connect outside services to Facebook and if you’re hitting the Like button on sites and connecting that to your Facebook profile, this will affect your privacy. There are also further instructions on how to protect yourself from Facebook’s F8 platform, with the caveat “as best you can.”

Another change that will affect everyone is the change to Pages. On people’s profiles, the Pages section will now be folded into Interests and users will be asked to convert Pages into Interests.

To quote from the CNN article linked to above:

So what happens when you are asked to convert your Pages into Interests? Let’s take a look.

When I logged into my Facebook account last night, I was informed that they had “improved” the profile so that it links to Pages, and I was offered the opportunity to convert my Pages. I wasn’t given a No option. Simply Link All to My Profile or Ask Me Later.

You can click on all images below to view larger versions.

You’ll note that in the image, there is small print saying, Learn more. When I clicked on Learn More here is what I learned: I learned that this was a really great thing that was going to enhance my Facebook experience and make my life an overall happier place.

There was no clear or accessible information to learn more about a decision NOT to convert Pages or how to not have them show up or even how it might compromise my privacy to just go ahead and Convert All as I was being encouraged to do.

In order to remove the Pages, I had to go at it sideways. I went back to my profile and selected Edit Information when viewing my profile.

Here is where I was able to select or deselect the Pages and confirm whether I did, in fact, want them on my profile.

Since the privacy updates will now make you connected to others via a number of your interests, I unchecked the boxes next to these Pages, and was subsequently warned that this would create blank spots on my profile. Okay with me.

Back on my main profile page, I was given a message to explain why some of my information had disappeared.

It is disturbing that never once in the process was I given any information about how the changes would affect my privacy. There was no link to a privacy policy or statement about what this step would do. There was just subtle pressure to go ahead and make the changes and warnings that I was going to make myself a Facebook pariah by not having certain information on my profile.

So where is this information to be found?

If you click on Help Center under your account on the right side of the screen, you will be taken to the Help pages.

In the Help Center, on the far right, there is a statement about New Profile Connections and a link to where you can Learn more about the new Community Pages and profile connections.

When you click on that link to learn more, here is where all the information I should have received upon login was hiding:

And of course, you can click on each topic to expand it, and there is the information about how this will affect the content on your profile.

Lots of people use Facebook. But not everyone is tech-savvy. There are moms and dads on Facebook, young people who are not tech-smart, teachers, doctors, and just plain old people who care about their privacy now and then. Even folks who are tech-savvy shouldn’t have to hunt around for updated privacy information.

So come on, Facebook. When you make changes that influence privacy, the very first pop-up we see when we sign into your site shouldn’t be a link asking us to Convert our Pages to Interests. It should be a link to how the action you’re asking us to respond to right now is going to affect our privacy.

Some further changes to Facebook?

There’s a Wall posting that’s been forwarded by folks saying:

FACEBOOK is at it again…violating your personal information: As of today, there is a new privacy setting called “Instant Personalization” that shares data with non-facebook websites and it is automatically set to “Allow.” Go to Account > Privacy Settings > Applications and Websites and uncheck “Allow,” then confirm that you’re opting out. Please repost.

I followed this path, and sure enough, here is what I saw:

When I clicked on “Allow” to deselect it, here’s the message I saw:

More information about how I may be depriving myself of a “richer” Facebook experience and the disclaimer that even opting out will not prevent my friends from sharing this information with others. Again, how come I had to be notified about this by my friends, Facebook, and not the service itself? Shady.

If you’re a mental health professional trying to keep a low profile on Facebook, you might consider emptying your profile of information you don’t want to share with people you are not directly connected to. Or, you may wish to also remove Pages/Interests from your profile to reduce the likelihood of being connected to others. A new option is becoming available which allows you to hide this information on your actual profile–again something I discovered through active searching but not made clear to me at any point during login.

A number of folks are talking about committing Facebook suicide. As we enter a new world in which our privacy is compromised without our notification, I can see the appeal.

Update, April 23

Kurt Opsahl at the Electronic Frontier Foundation also offers some detailed information on How to Opt Out of Facebook’s Instant Personalization.

One last note from me. A lot of folks recommend that you choose “Only Friends,” for many of your privacy settings. As I say to my colleagues, when it comes to Social Media, I am equal mixes of conservative, paranoid, yet adventurous. The paranoid part of me would like to recommend that you click on “Custom” for many of these settings and choose “Only Me,” for many of these settings if you really want to limit what folks can see on your profile. Why not? If they are really your friends, they know this stuff about you anyway, right?

The experiment

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

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

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

My issues with the Page

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

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

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

My experience

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

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

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

I also have never had a client become a Fan.

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

Why delete it?

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

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

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

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

Thank you

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

A planned termination

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

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