Ah the Internet. It gives so much to us in terms of support, connection, and the ability to obtain and absorb information.

And then, in an instant, it can also take so much away: feelings of pain, jealousy, feeling left out, or trying to interpret messages from pixels on the screen.

The Internet makes it easy to communicate without having to talk to people like some of us digital immigrants did in “the old days.” Don’t forget that the human relationships you most value do require some direct, face-to-face communication sometimes as part of their regular care and feeding.

Since so many of us are living our lives online these days, here are my six pointers for avoiding injury to yourself and others on email and social media.

1. Be careful of “heat of the moment” posting.

It’s so easy to impulsively respond to an email or a tweet or a wall posting when you’re feeling hurt or angry. But if you find yourself composing something when you’re feeling angry or shaken, try making it into a draft and giving yourself at least a 24 hour cooling period before clicking send.

If you have a trusted friend who you know to be a careful and balanced thinker or communicator, perhaps run your posting by him or her.

If you goof, and post something that maybe you shouldn’t have, you can still self-correct and delete it later. An apology may sometimes be a step towards a better interaction, as well.

2. Don’t use status updates as a passive-aggressive way to communicate something to just one person.

If you know you are really posting that tweet or status update for an audience of one, and it’s an indirect way to get something off your chest, try a direct message to the person you’re trying to to reach instead. Or better yet, send an email (or – gasp! – pick up the phone and call) and see if they are available to talk in the near future.

Don’t use vaguebooking or passive-aggressive posts to try to get attention. You may irritate people, and you may find that it doesn’t really wind up getting you what you want. Of course, private jokes or sweet messages can sometimes become a status update. But beware if you are using your twitterstream or Facebook Wall or G+ account as a way to beat around the bush.

3. Never unfollow or unfriend someone out of retaliation just because they unfollowed you.

Yes, it stings to find out that someone has stopped following your tweets or is suddenly showing up as a recommended Facebook friend when you know you were connected just a week ago.

If it’s a close relationship, you can always send a note and say you’ve noticed they stopped following you and ask why they did so. Don’t do this unless you are prepared to hear their answer.

But if you are still following them on Twitter and you like their tweets, don’t unfollow them to “get even.” Try giving it 30 days or so to see if they are still providing valuable content to you. If it’s still bugging you, and the relationship is close enough, you can ask why they took you off their Follow list.

If what follows is a “difficult conversation,” see my blog post on how to have difficult conversations.

And try those off of the Internet! Oh wait, that’s item #5!

4. Don’t obsessively Facebook, Google, or Twitter-stalk your ex (or the person your ex is now dating).

Of course, it’s tempting to find out what has happened in someone’s life when you’re no longer in it, and the Internet has made it ridiculously easy to browse photos, news, and updates on the lives of people who are no longer in our lives. In the old days (yes, this is a phrase I am now old enough to use), people might drive by an ex’s house in a moment of longing or self-loathing. But now we can just sit home in our pajamas and look at their social media profiles to find out what’s new with them.

But this has become a new form of self-injury for many people. Sometimes, it can feel like a compulsion and it can be hard to stop. If you find you are doing this, consider employing some harm-reduction strategies such as using the “block” function or imposing time periods during which you’ll stay away from the offending profiles.

Try 14 days of not looking. Then try 30 days. You may find that not looking helps you move forward and helps stabilize your mood.

If it helps, enlist a friend whom you can call when you have a weak moment. Ask your friend to help support you in choosing something healthier to do rather than checking these profiles.

Chances are good that the profile will still be there to peek at once you’ve had 30 days of sobriety from checking your ex’s profile.

5. Try to keep important and difficult conversations offline.

The online disinhibition effect can lead people to sometimes get closer online and share more than they would offline with positive effects. But it can also lead some folks to say things that are more cruel and toxic than what they would say if they were chatting face-to-face, looking into someone’s eyes and seeing how their words land. This can be problematic, if you want to process hard things in a friendship.

One of the worst things you can do is tell someone that something should happen in an offline chat, but then dump your side of the conversation into an email. That’s unfair and it only makes sense that a person would want to respond to that email.

So do both of yourselves a favor: if you think something warrants a face-to-face conversation, don’t start it over email. Send an email and say, “Let’s get together and chat, I’ve got some stuff I wanna talk to you about.” Or pick up the phone and do the same.

Unless you’ve got a proven track record with someone who also likes to process things over email, don’t assume this is the best way “to talk.”

6. Avoid inflicting FOMO on your friends (and yourself).

While it’s great to post photos and updates of all the cool and groovy things you do in your life, remember that people are going to see these updates who may feel very hurt and left out when they find out you had a big birthday bash and neglected to invite them.

Be mindful of what it means to have wide audiences who are now privy to your every social engagement and think about whether you really want to share these things with everyone or whether you want to create filters and friend groups so that you are not in inadvertently pissing off half of the folks you call your friends.

And if you’re prone to FOMO yourself, start booking up your own social calendar rather than cruising for online information of what you’re missing out on. If you’re feeling like you’re missing out on too much, it may be a sign that it’s time to work a bit harder on creating more offline activities for yourself than online ones.

For a long time, out of legal and ethical concerns, I’ve deprived myself of allowing comments on this blog. I had worries that clients might identify themselves or that people might share things in the comments that would make themselves vulnerable or which might require some action on my part or create an inadvertent clinical relationship between us.

But I’m going to begin experimenting with allowing moderated comments on some of my blog posts now and see how that goes. I plan to screen all comments before posting, not to be a heavy-handed control freak, but just to be sure that they contribute to the value of dialogue, community, and my site. Hateful, and abusive speech will not be approved.

I look forward to hearing from my readers and having conversations with you about my writing.

Thanks, as always, for checking out my site!

I’m back from SXSW, where I got rained on HARD and also got to network and socialize with some of my favorite people. My session was on the challenges raised by consumer reviews of healthcare providers. You can read the Storify story of tweets below.

Thanks to everyone who came and asked great questions!

Check out the audio from my segment of our presentation:

My slide:

You can also hear the full audio here, and view the Storify tweets below.

Tweets from SXSW session WARNING: Are Online Reviews Bad for Your Health?

Session moderated by Cindy Cohn, Legal Director of EFF. Panelists: Jeffrey Segal, CEO of Medical Justice, Dr. Keely Kolmes, SF Psychologist in private practice, and Vince Sollito, VP at Yelp.

Storified by Dr. Keely Kolmes · Mon, Mar 12 2012 14:21:29

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 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.

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

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

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

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

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

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

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.

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.