Managing Twitter As a Mental Health Professional

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

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