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.

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:

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.

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.

I have been getting frequent requests for certain archived blog posts on Social Media for therapists. As a result, I’ve decided to compile them on a separate page. I will continue to blog here, but I am launching a new page: For Clinicians Using Social Media on which I will summarize all of the posts for mental health professionals as separate chapters. This page will always be accessible from the top of my main blog page.

In the coming weeks, I plan to create a similar page for the posts that are more specifically geared towards demystifying therapy for consumers.

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

Just a couple of weeks ago, New England Baptist Hospital banned Facebook and other social media sites due to concerns that hospital employees were sharing too much about patient care in their online updates. The hospital was reasonably concerned that workers might be violating HIPAA and other privacy policies.

Thanks to a post by Dr. V of 33 Charts, I was led to Paul Levy’s blog Running a Hospital, where I read the full text of the notice the hospital sent about blocking Facebook, MySpace, and Twitter. I soon got sucked into the comments on whether health care organizations should institute blocks on employee access to social networking sites. My own comment is reposted below:

I think a more useful approach by the hospital would be to regularly review confidentiality and HIPAA practices and remind people that even locked, private accounts are not appropriate for posting confidential hospital information.

Blocking access during the work day will not guarantee responsible use after-hours.

I, myself, have occasionally been distressed to see therapists posting about cases without regard to the fact that the client him or herself may later see it (if a public account) or that someone on their follower list may see it and identify the person if it is a locked and private account.

So again, much better to educate internet savvy users about professional identity and how to understand and manage one’s professional role while still being an active user of social media.

As social media use develops and digital natives enter the field, healthcare organizations are going have to do much more to educate employees about the dangers of posting confidential health information. What if you have a locked account? You may feel that you are not providing enough identifying data to compromise a patient’s privacy in 140 characters, but what if one of your followers knows the family you just counseled on the loss of their child? Also, what does it convey to the public about how we embody our professional roles and responsibilities when we are frivolous about posting  the serious and personal issues our clients present to us? It’s worth thinking twice if you’re considering posting information about the session you just completed with your last client.

What about those who maintain public Twitterstreams and who post case details without identifying data? While nobody may know the identity of the male client who just sought your care for erectile dysfunction, what about the impact on the client himself if he should he happen to read your post? Is it fair to say that he may feel exposed? Ashamed? Objectified for the sake of your readership? And what if he’s shared with a close friend or his employer that he’s seeking care from you, but has not divulged the reason for coming to treatment? What if these people know when your client meets with you and later read your Tweets after a session? What if they then ask your client if your mention of the client with sexual problems was about him? We may think we have protected our client by not disclosing age or ethnicity, but in a public forum, we are providing much more information than we may realize.

Given how social networking encourages us to share the details of our days, it is becoming crucial for us to carefully consider our policies when it comes to updating our status updates in regard to our work lives. If you wouldn’t want your therapist Tweeting about your sessions, then think twice before you post about sessions you engage in with your own clients. And if you are a provider who intends to publish information to the web about the services you provide, then at the very least, your confidentiality statements and informed consent forms should reflect this fact and outline the steps you take to preserve privacy.

If you do make it your practice to blog or Tweet about sessions, make this a conversation that happens early in treatment and give patients the opportunity to “opt out,” of treatment with you, or the chance to “opt out,” of being used as a status update. And remember, it may be your day you’re posting about, but it’s your client’s personal life and it is protected health information.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) You have major depressive disorder. Mind if I tweet that? Retrieved month/day/year from http://drkkolmes.com/2009/11/03/ive-given-you-a-diagnosis-of-major-depressive-disorder-mind-if-i-tweet-that/.

Psych Central posted a list today of their Top Ten Psych Tweeps, and I was honored to have been given number one spot in their list. What a lovely surprise to wake up to this morning!

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

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

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

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

I have been working on a series of articles about Managing Social Networking Sites as a Mental Health Professional. I had initially posted this one about Twitter on Links for Shrinks, but I’ve gotten a couple of requests from other mental health professionals who are not on that network who wanted to view it, so I’m re-posting it here. Enjoy!

Managing Twitter As a Mental Health Professional

Social networking is great. It can be fantastic for our clients in terms of finding support and connection. It can also be wonderful for those of us who want to market ourselves or network with other professionals. It can even be good for us in the same ways it is for our clients: connecting us with friends or family members, and helping us to find our own support. However, there are also risks related to social networking for mental health professionals, and it is wise to carefully consider how you want to utilize social networks before plunging right in.

Professional vs. Personal

Any mental health professional considering joining a social networking site should first consider each network you wish to join and then develop clear goals, as to how you think you’d like to use them. One of the biggest risks of social networking for therapists is getting into sticky situations expressly discouraged by our ethics codes (i.e.– dual relationships, confidentiality breaches, and other boundary issues) when you do not clearly define for yourself whether you are using a social network as personal or business space.

So your first step when creating an account on a site like Twitter is to consider whether this space will be a place for you to market your business, or a place for you to interact with your friends. If you want to have both (and I believe we all deserve to have both!) I am a strong advocate for making two separate accounts for the two different purposes. If you are going to do this, be sure to use separate email accounts for the separate accounts you create on each network to minimize the possibility of work contacts and clients finding your private account and vice-versa.

Developing a Professional Presence

So now that you’ve opted to create a professional Twitter account, how do you manage it? When I am logged into Twitter as drkkolmes, I consider all of my actions and interactions to be part of my professional role as a psychologist. My professional Twitter account, like my professional blog, is an extension of my business identity. I am aware that I can be Googled by potential clients, current clients, past clients, employers, family members, or old school friends. I take great responsibility for what I post and consider it to be a part of branding myself as a serious professional.

To be blunt, I don’t use my professional Twitter account to post whether I’ve eaten a delicious sandwich, have walked my dog, or am off to meet a friend for tea. These are fine things to Tweet about, and, trust me, nobody loves raving about her food more than I do. But it is my opinion that these Tweets are more appropriate for a personal Twitterstream than a professional one. I recommend that you not use your professional stream to broadcast what you’re doing, when, or with whom. If you do wish to create a private Twitter account to share these kinds of personal tidbits, I recommend using a non-professional email address and locking your account so that it is friends-only.

Friending and Following

Some people believe that you should follow back anyone who starts following your Twitterstream. But when I am on a social networking site with my professional hat on, I am selective about who I friend and follow. On Twitter, I do not follow clients, and I do not follow friends. If you want see what your friends are up to, or you want to post personal updates, then by all means, create a private, personal Twitter account.

Why do I feel you shouldn’t follow clients? For a few reasons. First, it can easily compromise confidentiality by making visible a professional relationship. Second, it may invite clients to interact with you on Twitter in a non-secure medium (people you follow can direct message you on Twitter’s less-than-secure platform). If this were to happen, it brings into question whether or not these interactions become a legal part of the client’s records. Third, it brings into question clinical issues related to whether you are expected to pay attention to their updates and discuss these Tweets in treatment (and what if they Tweet that they are feeling suicidal?). Fourth, I want to use Twitter to receive professional updates about the field of psychology–not to get information about my clients’ lives, which I prefer to hear about in-session.

This is also a good time to mention that I actively discourage clients from following me on Twitter. If I happen to recognize that a client has followed me, I wait and bring it up in-session. I talk a bit about my concerns about their privacy and I will suggest that they subscribe to my RSS feed rather than following me. It’s not that I don’t want a client to see my Tweets. It’s that I want them to be aware that having an online link to me could potentially lead to someone guessing they might be my therapy client. Some may decide this feels okay and continue to follow me anyway, but I think that at the very least, it’s worth a conversation. This conversation also allows for us to acknowledge the impact that it can have on the therapy relationship when it moves out of the room and into cyberspace. It also opens the space up for us to return to this, in the future, if needed.

Who will I follow on Twitter? Mainly other mental health professionals. But not just any mental health professional and not just anyone who follows me. You, of course, need to decide who provides valuable information to you. What I am looking for on Twitter is to engage in professional conversations, to obtain mental health news, and to connect with others who are thinking–and posting–seriously about mental health concerns as they relate to technology and social networking.

Sometimes, I may start following another therapist on Twitter, but if I discover that she’s mostly posting about her own personal emotional struggles or what song she’s listening to on the radio, I usually will stop following her pretty quickly. This may seem cold, especially for folks who are used to negotiating and communicating about relationships. But again, it comes down to weeding out the information that’s not useful to you. If someone is not adding relevant news or information related to what you are looking for on Twitter, you don’t have to feel apologetic for un-following them. There are plenty of followers to go around!

Once you’re following more than 30 or so folks on Twitter, that can be a lot of information to scan through, and it can be easy to miss the information that is most meaningful to you. Your mileage may vary, of course, but make sure you are following people who post information that is useful and interesting to you as a professional. And, feel free to re-evaluate and modify your Follow list over time. This is also where Twitter lists can become useful. You can organize people you want to follow into lists and this can help manage the stream. There are also a number of Twitter apps (or tools) that can help you manage and track the people you follow.

Some Clinical Cautions

Of course, it goes without saying that whether you keep a public or private account, mental health professionals should avoid Tweeting about any clinical material that comes up in therapy sessions. Even if you mask identifying data, avoid names, or generalize, it can feel incredibly exposing to a client to come across a Tweet about something that happened with them in your office. It is also easy to assume that those who follow you do not know your clients, but that’s a dangerous (and oftentimes erroneous) assumption.  Just don’t do it. Your clients will be happier and you will be protecting your practice.

Also be aware that even if you only Tweet about professional issues and news, some clients may experience it as very un-containing simply to see you existing outside of the therapy room in online space. It can be irrelevant to some clients, but others may find it discomforting and you should be prepared to engage in conversations about it. In addition, be mindful that even if you are only Tweeting professional updates, you are still revealing information about your habits, your schedule, and when you are awake at night by what and when you Tweet. If you do choose to use Twitter to also post personal Tweets, again, be aware of how this could impact your current clients.

It is also good to be aware that you are not only making yourself visible to your actual clients, but to other people in their lives who may know they are in treatment with you. This could be friends, partners, and family members. So be aware that you are choosing to make yourself visible in the world in a way that may potentially have an effect on your clients’ relationships and the perceptions of others in their lives about you and your practice.

If you have emailed at any point with your clients with the email address you use to create your Twitter account, you should be aware that you may come up in your client’s search when they look for “friends,” on the Twitter site, and vice-versa. It is very easy to accidentally, with a click of a button, auto-follow everyone in your address book. So be careful of this and also recognize that a client may follow you accidentally through this feature, and vice-versa.

Twitter Faux-Pas

How can you muck up your professional Twitter profile? Don’t interact with others or respond to questions. One of the lovely things about Twitter is that you can interact with many people. If someone posts a question that draws you in or is relevant to the work, by all means, reply. One of the things I most love about Twitter is that you can still participate in conversations with folks on Twitter, even if you are not formally following them. I peek at lots of posts and conversations Tweeted by people I’m not regularly following. I also review my own @replies often and can see if someone has asked me a direct question. I can easily @reply back without having to follow the person if they do not regularly post updates of interest to me.

Another thing you can do wrong on Twitter is post questions and then fail to acknowledge those who responded to them. If you are putting out questions to the Twitterverse, by all means let folks know you have seen and appreciate their responses. Otherwise, it can feel very one-sided and people may stop responding to your questions since you don’t seem really engaged in a real exchange. In that same vein, be careful of only using Twitter to promote yourself. I’ve seen some people whose only Twitter posts are their blog updates or news about their businesses. Even worse, is making your Twitterstream consist solely of automated blog feeds. This becomes tedious very quickly. Anyone can RSS to your blog feed if they are interested, but if you are using Twitter, then make it interactive. Rave about someone else’s site or link to useful information that others have provided. Share and promote others. It will come back to you.

Time to Tweet

If you’ve been itching to get onto Twitter, go for it. Post some questions, link to some articles, and if you have a website or blog, let folks know when you update it. If you see someone posting something that you like, Retweet it (you do this by posting RT @theperson’s name and add the link they posted). Of course, feel free to join and just observe for awhile. It’s okay to follow people and think for a bit about what you’d like to say. Nobody’s going anywhere.

So now it’s time to Tweet! Be cautious, but have fun, and start connecting. There is a lot of good information to find and share, and there are a lot of potential relationships to build.

© 2009 Keely Kolmes, Psy.D.

To cite this page: Kolmes, K. (2009) Managing Twitter as a mental health professional. Retrieved month/day/year from http://drkkolmes.com/2009/05/04/managing-twitter-as-a-mental-health-professional/.

Tonight, I’ll be heading to Vancouver to attend tomorrow’s all-day Mental Health Camp (Un)Conference.

I’m very excited to be in a place with others who will be talking about erasing stigma towards mental illness and how social media can expand the possibilities for healing and support. Can blogging, Twittering, and Facebooking provide therapeutic healing?

Isabella Mori and Raul Pacheco-Vega will be presenting the Keynote on Social Media and Mental Health. After that, twelve sessions will follow. It’s always a challenge at conferences to choose between two fascinating sessions, and Mental Health Camp will be no exception.

Some of the panels I’m most excited about are Sandra Kiume’s presention on Mental Health Marketing using Social Media which, of course, is going to be at the same time as Lorraine Murphy’s presentation on Anonymity, Pseudonymity: Freedoms, Dangers, and Responsibilities. Both of these topics interest me and I will sadly have to choose between them.

Karen Quinn Fung will be presenting on Mental Health and Cultural Sensitivity: Services and Stigma in Vancouver’s Ethnic Communities. While I don’t live or practice in Vancouver, I’m interested in this topic. But it also is during the same time as Airdrie Miller’s ERROR 404 Page Not Found presentation which is a personal story about choosing to take her blog down.

If you want to know more about the panels, you can read the full descriptions or just see the schedule.

I know the organizers are taking steps to protect people’s privacy while also sharing information that comes out of the conference with the web community at large. I know many people will be blogging about it, and I will try to link to some of those blogs when I return.

If you want to follow Mental Health Camp on Twitter, you can look for hashtag #mhc09 or just follow all Twitter conversations about Mental Health Camp.