The Bay Area organization, Gaylesta, (The Gay, Lesbian, Bisexual, Transgender Psychotherapists Association of the Greater San Francisco Bay Area) is organizing a project called 50 Things You Need to Know About Working with LGBTQ Couples.

They are asking both psychotherapists and LGBTQ couples who have gone to therapy to submit brief information about that experience that would help other therapists. The goal of this project is to collect and share information will help other therapists to provide better care for LGBTQ clients.

Please note that the deadline to submit this information is February 1st. You can send your responses to: gro.atselyagnull@tcejorpselpuoc

You can find out more about the project here.

Some of the information Gaylesta would like to know from clients includes:

• How important is it that your therapist be willing to disclose their sexual identity?  Does it matter to you whether they identify as LGBTQ? Why or why not?
• How have differences related to class/race/ethnicity/religion/etc. impacted your relationship?
• What was particularly helpful or not helpful in the way your therapist supported exploration regarding sexual difficulties?
• How has your therapist been able to be supportive or not during the transitioning of one member of the couple?
• If applicable, what has helped you feel that your therapist has understood and supported your alternative relationship constellation (i.e. polyamorous or nonmonogamous)?
• What do you wish your therapist knew about your identity and/or life that would (have) help(ed) in the therapy?
• What technique or insight initiated by your therapist in relation to you being LGBTQ helped the therapy?

Please note that this is not research and it’s not anonymous. Gaylesta intends to compile the responses, however your name will be removed from them.

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:

Are you a person 18 years old or over, who has been in psychotherapy, and has sought or found information about your therapist on the Internet? If so, we would appreciate your taking the time to complete a survey.

Our names are Keely Kolmes and Dan Taube and we are licensed psychologists who would like to request your participation in our research on the effects of encountering your past or current therapist’s information on the Internet. This study has been approved by the Institutional Review Board of Alliant International University.

As a participant, you will be asked to complete an online survey covering your basic demographic information and your experiences regarding seeking or accidentally discovering information about your therapist on the Internet. We expect the survey to take about 20 to 35 minutes to complete.

Your input may help therapists to better understand if and how this information affects clients.

No names or personal information will be linked to the study and your participation will be completely anonymous so long as you do not put your name in your responses. If you should wish to contact the researchers directly, your participation may become confidential rather than anonymous, although your name will not be linked to any of the data you submit.

To be eligible for the study, you must be 18 or older, currently in psychotherapy, or have been in psychotherapy in the past, and have encountered or sought information about your therapist on the Internet.

If you meet the above criteria and are interested in participating in the study, you can access the survey at:

http://www.surveymonkey.com/s/finalclient

If you do not qualify for the study but you know others who might be interested in participating, feel free to forward this notice or URL. You may also share our research page with others on Facebook.

Thank you for your interest and participation.

Sincerely,

Keely Kolmes, Psy.D. moc.liamhsuhnull@semlokkrd

Daniel Taube, Ph.D., J.D. ude.tnaillanull@ebuatd

Therapist-Client Interactions on the Internet

Thank you to everyone who participated in our survey. The summary of the results of the research Dan Taube, J.D., Ph.D. and I conducted on psychotherapists who have had intentional and accidental extra-therapeutic encounters with their clients on the Internet are posted on my research page. A larger slideshow can be viewed here.

To read a brief lit review and description of the research, please see our article Clinical implications of therapist-client interactions on the Internet: Boundary considerations in cyberspace.

Funny vs. Not Funny

Recently, on a professional listserv, someone posted a joke that a number of people found offensive. As the flood of responses filtered through, the listserv became divided. Some were disturbed to see the joke posted in a professional forum. Others defended the joke and the joker. As the conversation evolved, it became clear that the sender had knowingly posted the joke, that she thought it was funny, and now she felt hurt and misrepresented by those who found it offensive.

Well, there we were.

That was racist!

The thread brought to mind one of my favorite web videos called “How to Tell People They Sound Racist.” The video provides a model for how to talk to people when they’ve said something offensive and how to bring the focus to what was said rather than the speaker’s intentions.

While reading the exchanges on the e-mail list, I started to realize how much more useful it would be to have guidelines for how to respond when someone tells you that you’ve said something racist or otherwise offensive. This is an even harder task, and it’s where many of us probably need the most help.

Think of it this way: If someone tells you that you stepped on their foot, you don’t usually say, “How dare you think I’m someone who goes around stomping on feet! I’m offended that you would make such a negative assessment of my character!”

Of course, not. That would be ridiculous. Instead, most people say, “Oops! I’m so sorry!”

Why then, is it so difficult to respond in this fashion when someone says we’ve said something racist, offensive, or just plain hurtful?

Deconstructing difficult conversations

I see couples who struggle with this very problem on a much smaller scale. Let’s take the racist and offensive part out of it: two people come to my office trying to be heard, messages are getting misinterpreted, and both partners wind up frustrated, sad, or angered by these failures to connect. Maybe they want to give up entirely.

I do a lot of work with couples about communicating their feelings in conflict and how to respond in ways that help each of them get heard. Oftentimes, this means separating an accusation from the expression of hurt feelings. Sometimes one partner hears that blame even when the first partner hasn’t made any accusation. We work on restructuring a better interaction, slowing communication down, and tracking where and how it went off the rails.

Private vs. Public

I can think of few circumstances more challenging than being told you’ve said something hurtful or offensive to another person (other than perhaps having to be the one to bring up the hurt in the first place) even in private. So imagine how this challenge can be even more compounded if you’re told you’ve said something hurtful to an entire group, it’s in public, and it’s a professional setting with an audience of hundreds.

Yikes. Talk about a context for a difficult conversation!

The most natural thing to do in such a situation is to defend yourself and explain your intention. This is the “You should not have been offended by what I said and here’s why….” tactic. It feels right because most of us don’t intend to hurt other people, so it feels true. But….it misses the point.

A better alternative

If I’m ever in such a situation, what I hope to do would look a lot like what I try to do in smaller scale conversations and what I try to teach my couples to do: offer a validating response. This includes acknowledging the hurt or offense (even when you don’t necessarily agree that it should have hurt), recognizing why it may have been hurtful, and then — if you can muster it — expressing some appreciation to the person for letting you know and for educating you.

Try these steps:

1. Breathe
2. Acknowledge the hurt and offer validation.
3. Show appreciation to the person for letting you know.

Here is what that could look like: “Oh my, I can see how that sounded awful. I can imagine it hurt your feelings and maybe the feelings of others who heard it as well. I’m glad you brought it to my attention so I can be more sensitive in the future. Thank you for gently teaching me something here.”

These things typically should come before you explain where you were coming from. If you’ve conveyed an interest in hearing how you affected the other person, they are far more likely to be interested in hearing what you meant to say. Of course, all of this is much easier to imagine when you’re outside of such a conversation!

When we are in these conversations, we feel attacked. Or embarrassed. We defend. We forget to breathe. We get lost.

Give yourself (and others) a break

Take a moment to consider how much grace it takes to pause, reflect, breathe, and respond in ways that promote and preserve goodwill and understanding. Make an effort to try to bring this into your next difficult conversation. These are the conversations that could happen and that need to happen, both in one-on-one conversations and on a collective level.

Practice makes perfect

Remember that these skills can be learned and improved upon and they do get easier with practice.

Also conversations and relationships are ongoing. If you think you messed up a conversation that could have gone better, that doesn’t mean it’s over and gone forever. Try asking for a do-over. Or notice that you didn’t respond the way you would have liked and say you want to go back and say what you think you left out.

Most people are happy for the opportunity to feel better and this is a great way to show that you really care and you’re making an effort.

Our networking group for Bay Area Psychotherapists has a new mission statement:

We are a group of San Francisco Bay Area psychotherapists and psychotherapy students who affirm that sexual and gender diversity are natural expressions of the human experience.

We provide a safe haven for mental health clinicians to gather, network, support, and
consult.

Our psychotherapy practices welcome and serve:

● Clients who engage in consensual sexual behaviors, including but not limited to kink and polyamory.
● Clients who are gender variant.

Our group welcomes:

● Students seeking mentorship in working affirmatively and responsibly with said clients.
● Professionals seeking networking, support, and consultation in working affirmatively and responsibly with said clients.

We are committed to expanding affirmative psychological understandings of sexual and gender diversity, and to counteracting the historical and present day harm done by pathologizing diagnoses, stigma, and invisibility.

We are committed to identifying standards of affirmative and culturally competent care, and to sharing this information with each other and our colleagues so that we may better serve our clients and their communities.

We have all agreed to abide by the ethical guidelines of our respective disciplines.

If you are interested in joining our group, please email Keely Kolmes, Psy.D. PSY21284

In your email, please provide your name, license, practice and/or school information, and a brief bio about your interest in the group. This information will be shared only with other members of our group.

We look forward to hearing from you!

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

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

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

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

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

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

4. This will bring you to the following screen.

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

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

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

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

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

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

Media psychology

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

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

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

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

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

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

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

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

Establishing a professional relationship

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

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

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

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

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

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

Responding to Interview and Guest Writing Requests

Getting your point across

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

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

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

Maintaining confidentiality and obtaining informed consent

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

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

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

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

Providing commentary on public figures or news items

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

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

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

Other issues related to client rights and dignity

Whose status update is this anyway?

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

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

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

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

Conclusion

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

References

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

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

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

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

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

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

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

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

© 2010 Keely Kolmes, Psy.D.

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