The SXSW 2010 PanelPicker is live today and I’m very excited about the panel that I have submitted for SXSW Interactive with John Grohol, Psy.D., CEO and co-founder of the mental health network, PsychCentral.

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

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

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

Psychology and the Internet: From Freud to Facebook

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

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

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

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

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

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

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

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

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

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

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/.

Pre-panel, Photo by Thomas Roche

I wanted to provide an update on my recent experience at SXSW Interactive. I didn’t get to go to every panel I’d wanted to attend, but I believe most people come home from SXSW feeling that way.

Therapy 2.0: Mental Health For Geeks which I co-presented with Thomas Roche, was well attended with somewhere between 50-60 people in the room. As the room filled up, I wondered whether a group of this size would really allow for  a conversation, but I was pleasantly surprised to experience people talking with one another and sharing ideas, as opposed to simply directing their comments back to Thomas and me. There was quite a bit of energy in the room as people talked about how they sometimes feel overwhelmed by information. Some mentioned issues with non-privacy while others talked about the illusion of intimacy that one gets with social networking sites. One person observed that the frequent interruptions of technology have changed her experience of what it means to be alone, which I found interesting. People talked about their own tips for keeping healthy which included hobbies, breaks, exercise, and techniques such as leaving their devices at home.

Since we were doing a Core Conversation, rather than a formal panel, I wanted to create some resource so that folks could obtain information, if they felt compelled to do so after talking about all of these issues. With that in mind, I created a Therapy 2.0 wiki where folks are welcome to find out more. Please feel free to check it out for information related to self-assessment, books, online tools, and how to find a therapist. We ended our Core Conversation with my list of five things you can do now to improve your mental health. These are also on the wiki, but I am also sharing them here.

In summary, I had a wonderful time presenting at SXSW this year and am looking forward to returning next year, regardless of whether I’m presenting or simply listening and learning from the other inspirational panelists and attendees who show up each year.

Five Things You Can Start Doing Now to Improve Your Mental Health

1. Weekly gratitude practice

Research shows that keeping a weekly gratitude journal has significant effects on increasing optimism and decreasing reported physical symptoms. But don’t overdo it. Lyubomirsky et al. (2005) found that those who practiced gratitude three times per week saw less benefit than those doing it once a week, suggesting that there may be a habituation effect and loss of gains if you do it more than once per week. Consider putting a reminder in your calendar to do this once a week.

2. Breathing exercises/Mindfulness practice

If you find yourself feeling stressed or anxious, doing a simple breathing exercise can help lower your blood pressure, lower your heart rate, and bring your attention away from distressing thoughts. It is easy to let future-focused or past-focused thoughts get in your way and this can increase depressed or anxious feelings. Be sure to breathe deeply into your lower abdomen, rather than taking shallow breaths just into your upper chest.

Breathing exercises are one component of mindfulness which is the practice of staying focused upon the present moment. There have been many studies showing the beneficial effects of mindfulness practice on depression, anxiety, sleep disorders, stress, chronic pain, and other ailments. When practicing mindfulness, sit in a comfortable place and start with the breathing. Then focus simply on being in your body. Notice your weight in the chair and the sounds you hear. If worrisome thoughts enter your mind, bring your focus back to your breath. Try to do this for 5 minutes a day and work up to 15 minutes.

You may also consider searching for podcasts that offer relaxation, breathing, and mindfulness exercises.

3. Connect with others

There is much data suggesting that social support and connection increases mental health and feelings of self-worth while simultaneously decreasing stress. Consider joining an activity group, taking a class, or even volunteering somewhere.

Have a lot of work to do? Try co-working or just go to a cafe to get your work done.

4. Exercise

There is significant data indicating that exercise relieves symptoms of depression and anxiety while also helping with insomnia. Consider combining exercise with connecting with others by joining a gym or a boot camp or organizing physical activities with friends.

5. Thought-tracking

If you’re struggling with anxiety or depression, tracking thoughts and moods can be helpful. Thought records are a cognitive-behavioral tool that can help you examine thoughts and beliefs and how they influence your mood. You may notice patterns and less useful beliefs that come up in your inner monologue with yourself. Identifying these thought patterns can be a first step in changing them.

I’ve joked for weeks that I’ve been wanting to blog about procrastination, but other things kept getting in the way. Joking aside, this is a serious matter. Even if you don’t procrastinate, most of us have experienced difficulty in structuring our time to complete a task at one time or another. This can happen with small, nagging tasks such as housecleaning or picking up an item from the store. It can also happen with large, ongoing projects, which can take on a looming presence in our lives as time keeps slipping away.

As someone with a passionate relationship with the the technologies I use, I can be a bit defensive when people pathologize internet and social networking technology. However, living in a culture of constant distraction certainly has an effect on our attention and concentration, even if we don’t have Attention Deficit Disorder. We are constantly being interrupted by our cellphones, SMS messages, Instant Messages, RSS feeds, Twitter updates, news headlines, email inboxes, and Facebook wall updates. All of this input can contribute to problems with task management. Information overload is also changing how we communicate: people are now microblogging and exchanging smaller snippets of information. This may be an adaptive way to connect with others, but it’s not always the best way to complete larger work projects.

Staying plugged in while still managing one’s time wisely is challenging. I’ve spent the past five years working in the counseling center at Stanford University, where I have seen many graduate students try to manage large chunks of unstructured time while working on their dissertations. Here are some time management tips that have been useful with these clients. They can also help you if you’ve fallen under procrastination’s spell.

1) Short work periods

If you have gotten really stuck on a project, try scheduling a 30-40 minute work period for your first day of getting back on-task on a project. Clients usually think I’m kidding when I prescribe such a short work block, but I am astounded at the number of people who come to see me who set aside 6 hours of work time and then are frustrated with themselves for not using the time well. Think of it this way: it’s much easier to mismanage 6 hours of time than it is to mismanage 40 minutes of time. This is especially true if you’re already reinforcing poor work habits. Get in the new habit of experiencing what a productive piece of work feels like. Keeping to short work periods helps create reasonable expectations while helping you build your skills and focus. It will also help you by leaving you feeling satisfied and productive, rather than angry at yourself for wasting time.

Tools

I tell clients to use an old-fashioned kitchen timer if they can find one, since it’s big, hard to ignore, and somewhat symbolic while you see it running out of time. There is the added tactile experience of twisting the time up when you set it, which may help to jar you from unconsciously web-browsing back to conscious work mode. Plus it’s one less thing to fiddle with on the computer.

Some people prefer to download different timers or stopwatches and use them instead.

2) Eliminate distractions

Have a big project to do? Turn off your cellphone (and that means turn it off vibrate!) and stick it in your backpack. Don’t leave it sitting on the table in front of you. Close your IM software, or at least go invisible. Close your web browser if you can, but if not, then close windows that are not work-related. If you have an email notifier, turn it off.

Is 40 minutes without access going to make a big difference? If you create room for interruptions and distractions, they will find you. It seems pretty straight-forward, but lots of people have gotten used to letting technology tap them on the shoulder every two minutes, and deciding that you’re going to be unavailable during your short work period will help immensely, at least for the outside interruptions.

Tools

If you need access to the web for the project you are working on, you can also use tools like LeechBlock to lock you out of specific websites for a specified period of time if you fear you will browse away from the project during your blocked out work time.

3) Schedule reward and break periods

When people are just starting to get back into good work habits, I recommend they start with 30-40 minutes of work each day. For many serious procrastinators, 6 days of 40 minutes of work is already three more productive hours of work a week than they’ve been completing. If someone is able to manage this and feel successful, we’ll talk about sandwiching an hour of internet playtime between two 40 minute chunks of work next. It is just as important to set the timer on the break periods as it is to set it during the work periods. After success with this, we’ll talk about increasing stamina to four work periods a day, with breaks scheduled and we may move the work period to 60 minutes with 40 minutes for breaks, internet browsing, research.

4) Break large tasks into smaller ones

Many people have difficulty because the size of the task. This can be particularly daunting if it’s something like a book or dissertation. Large projects can easily overwhelm a person. Start breaking projects into smaller pieces. Get specific about what you want to do with your block of work time and be reasonable. It may make more sense to start reading and reviewing one article than thinking you’re going to write ten pages of your lit review in one work session. If you’re having trouble breaking up your tasks, schedule some time with a friend who may be able to help you get organized and help you assess what a smaller task really is and whether it is manageable.

5) Get support

Try co-working or having a project partner. Getting together with someone for 1-2 hours of work a couple of times a week can help you to be accountable. It is sometimes easier to have to show up for someone else than it is to show up for yourself. Agree at the beginning of your work time on what tasks the two of you are hoping to complete. Check-in at the end of the work session and set an agenda for your next work date. If you can’t get together to work, plan a phone check-in at a set time later in the week to update one another on your progress. If you don’t have a partner, try Googling co-working and your city. Many cities have co-working networks and resources for people who want to get together and work.

Some other good sites and resources

Some people like to use tools to track their time to get a baseline measure of how and where their time is being spent. I don’t recommend people start with this, as it can add to the distraction or just bring up feelings of shame and defeat about misuse of time. But if you’re interested, RescueTime is a time management software that can do this for you. MeeTimer is a Firefox extension which does the same thing.

David Allen, the author of  Getting Things Done (GTD), a strategic approach to workflow management, has sparked a large movement of devotees. You can find a 1:26 minute podcast over at 43 folders, where there is another great post about his concepts in practice.

I love Cory Doctorow’s piece on Writing in the Age of Distraction.

Thanks to Tim Ferriss for his post on How to Use Twitter Without Twitter Owning You in which I was tipped off to the software recommendations in this post.

I have finally created a professional Twitter account for those who want to get notices of my blog posts and other information over there. Feel free to follow me for updates regarding my practice as well as other mental health related news. Please note that I will only be following other established mental health professionals and organizations.

I have used Twitter socially for over two years now and have always been impressed with it as a way to quickly disseminate information across communities. Last fall, I discovered that one of my closest friends was in the hospital having emergency surgery, thanks to a mutual friend’s tweets. If not for her messages, I’d likely have not found out until days later, when my friend had the strength to email. During a recent dinner with another friend, she noted that Twitter has become a faster and more useful resource for local information on earthquakes than the previously relied upon California and Nevada earthquake Index .

But there are more things that you can do with Twitter, besides staying updated on personal or local updates. I just watched a fabulous online presentation entitled Twittering and Plurking for Work and Health , by PF Anderson, Emerging Technologies Librarian at the University of Michigan. She gives a fantastic overview of how these social networking technologies can be utilized by healthcare providers and patients to enhance productivity, learn about health legislation, mobilize activism and support, and to have more accessible relationships with providers. You can click through her slides for a quick overview, or play them with audio for the full 60 minute presentation. I am excited to see how technology is creating new avenues for patient care and empowerment, and I am looking forward to expanding my use of new web tools in productive ways for the clients who work with me.