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1. Remember that Confidentiality is our primary duty to our clients.

Confidentiality means more than not telling people the names of your clients. It also means that we remember that when we are posting status updates (whether on personal or professional social media accounts), we remain aware that these can be read by both our clients and those who know them.

In our training and education, we learned that name/age/sex/gender/ethnicity/race/etc. were components of confidential information. But now that many of us have pubic internet lives, we can quickly forget that there are people reading our tweets and status updates who may be friends or colleagues of John Doe, and they know he sees his therapist Dr. Keely Kolmes at 3pm on Tuesdays. So if you post at 3:55 that you “just had a wonderful session with your client who finally is seeing a reduction in his depression and is ready to tell his boss to take a hike,” you may have just revealed far more to people in John’s life than you realized.

Keep your tweets to matters like psychoeducation, health news, or the work of your colleagues and not about the people who come to see you, and you and your psychotherapy clients will be happier for it.

And as a bonus reminder, think about what you post in referral or consultation requests on listservs. These are messages seen by hundreds, if not thousands, of providers. One of them may know your patient, so share the minimum information necessary and then take the conversation off the listserv to provide more details.

 

2. Most ethics codes state that we should avoid multiple roles when they can lead to a loss of objectivity or exploitation of a client.

When we’re on the Internet, it may be harder to distinguish what exactly constitutes a multiple role. For example, friending or becoming a “contact” with a client on a social media site isn’t quite the same thing as deciding to become friends with a client’s spouse. While this may be true, there are subtle ways that adding psychotherapy clients to our contacts on social media sites can blur the lines of our professional role with them. Here are two examples:

1) It allows them to connect and network with the other people in our social network. This means that if you have other patients or even friends and family members who are part of your connections, and these people post on your Wall or social media pages, now your client can forge connections with these people. They may have no ill intention, but if we are not enforcing these boundaries, we may be surprised to discover the relationships that flower when we accept such requests. So, bear this in mind. You may not want your client getting into an argument with your brother on your Facebook wall. 

2) Similarly, on a site such as LinkedIn, it is not uncommon for people to request introductions to people in your network so that they may seek a job at their company. Or they may ask you for an endorsement. It could be quite awkward if one of your close friends asks for an introduction to your client so that she can seek employment at your company.

Not connecting to your clients on social media can be a quick and easy way to avoid getting into one of these sticky multiple roles with them.

3. Use a separate email address for your social media account(s) than the one you use to correspond with clients.

Some people don’t use email with clients, but many of us do these days. One pro tip to avoid being suggested as a potential contact is to use a completely separate email address for your login and contact information on social media sites (or a different phone number). It’s still possible that the site will note you have contacts in common and recommend you as someone to add, but you can reduce this possibility if the email address you use on the social media site is not the same one the client has in their address book.

Also, if you keep client’s names in your phone (versus a secure HIPAA-compliant app), they will come up as recommended contacts. So many social media sites ask us to grant them access to our phone or email contacts, so it can be better to use an email address that doesn’t contain confidential contacts.

In fact, I’d advise taking things a step further and using an email provider that doesn’t double as a social networking site (meaning no gmail, yahoo, etc.) specifically for emailing with your clients. Sites that are based upon security are not likely to expand their services to create new social network offerings that could blur or expose the contacts we wish to keep secure and confidential.

4. Remember that asking for testimonials from current clients or those vulnerable to “undue influence,” is considered unethical for most disciplines. 

This means asking clients to leave you a Yelp review is a no-no. And remember that the last therapy session, in which you are consolidating all of the good work a patient has done is still considered active therapy. So don’t try to wiggle past the rules by asking clients in the last session to leave a Yelp review. This can shift the focus from the client to “what can you do for me?” and can taint what might have been a perfectly graceful ending to therapy. I have personally heard from psychotherapy clients who were angered and felt pressured when a therapist asked them for a Yelp review in the last session. Some have said that it altered their entire view of what had, until that point, felt like very good work. So just don’t do it!

5. To Google or not to Google? Make this an Informed Consent Issue.

One of the most hotly contested issues in psychotherapy circles is whether or not it is ethical to Google patients. Forensic clinicians understandably have different roles and motivations for investigating people. But clinical psychologists develop relationships of trust and integrity. So how about putting it in your policies and make it part of Informed Consent, and let patients know from the outset whether or not this is one of your practices? It can prevent a patient from feeling violated.

This way, your practices are transparent and understandable to your clients, whether or not you are a clinician who believes in Googling all clients before they come in, or if you are someone who only does Internet searches on people in your practice if something seems “off,” or if you’re someone who doesn’t ever engage in Internet searches on your clients. Whatever it is you do, live by the rule of “no surprises,” and let your patients know what they are agreeing to when they come in to see you.

What next?

If you are looking to learn more about digital and social media ethics, you have a few options open to you:

And you can always email me at drkkolmes@hushmail.com or call me at 415-501-9098 if you think I can be of help.

See you online!