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(p. 157) Technology Considerations in Running a Private Practice 

(p. 157) Technology Considerations in Running a Private Practice
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(p. 157) Technology Considerations in Running a Private Practice
Author(s):

Ellen Belluomini

DOI:
10.1093/med:psych/9780190272166.003.0013
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Subscriber: null; date: 20 September 2017

Technology can offer challenges and opportunities for the private practitioner. This chapter first explores how psychotherapists of different ages experience boundaries and the Internet. The discussion progresses to methods of integrating technology assessment and digital testing and the impact of technology on the management of a private practice. Digital options per se are not unethical or inappropriate. Each area is viewed through a risk management and strengths lens. The intent is to guide the psychotherapist through the potential complications of digital options while emphasizing the ways in which technology can ease the management of a private practice.

Different Generations of Technology Users

Two concerned parents brought their 14-year-old son, Jason, to psychotherapy for symptoms of depression. They identified isolation from family, sleeping after school, and a lack of interest in prior friendships as behavioral indicators. His A average at school dropped to all C’s during his freshman year. Jason presented as a precocious and outgoing adolescent who did not appreciate his parents’ concern. The initial family intake provided dichotomous evidence of depression.

Jason shared his side of the story the next week. He said he had many friendships, but they existed primarily online in forums and chat groups, by instant messaging, and on social media sites. He became friends with “a man” in his 40s through an online forum on computer programming. This camaraderie boosted Jason’s self-esteem as this online friend worked with him to develop new (p. 158) programs. They spent hours online late at night talking and hacking into various systems, including maneuvering through his parents’ security firewall. He felt like an adult, not a teenager.

Jason spoke with ease while he proudly exhibited his aptitude with the computer in sessions. I asked about the most interesting computer trick “the man” he was working with showed him. Jason demonstrated a hack at the same time discussing his intent to purchase a bus ticket to New York during the long weekend ahead to meet him. The plan developed without the consent of his parents. Besides the goal of keeping this adolescent safe, I realized technology was going to be an integral part of assessment, relationship building, and treatment with Jason. This family’s situation marked the beginning of practicing digital awareness in my sessions.

This scenario transpired over 12 years ago. Since then society has seen a rapid increase in technological innovation. Circuit speeds double every two years, bringing upgrades and new digital applications with this progress. The time involved to produce an information generation gap of technological progress continues to shorten. This gap is evident when we compare each generation’s use of technology. Pew Research Center Internet, Science, and Tech researchers provide ongoing analysis about each generation’s adaptation to a technologically advancing society.

Prensky (2001) coined the terms “digital immigrant” and “digital native” to describe those using the “language” of technology. Digital immigrants learned this new language of technology but did not grow up with technology. In contrast, digital natives grew up fluent in the thinking patterns of technological use. Digital immigrants notice these innovations and must work harder at decoding the uses for digital tools. And even digital natives, who grew up in a digital world, may struggle as innovation accelerates the learning curve.

Boundaries in a Digital Age

Digital immigrants grew up with boundaries that consisted of well-defined ethical constraints. Only 20 years ago, psychology programs offered strict guidance against giving personal information to clients. Personal information consisted of a home phone number, address, and many personal details of the psychotherapist’s life; even having pictures of family members in an office might have carried disapproval from colleagues. Following these guidelines created a sense of security and privacy for the practitioner and a safe, therapeutic environment for the client. Solutions to ethical dilemmas used a distinct formula of right and wrong scenarios, but then technology blossomed and these formerly sharp lines of ethics became imprecise.

Personal data are now in the public arena thanks to the Internet and search engines. Tech-savvy clients are now just a Google search away from learning details of their therapist’s private life. The reaction of many practitioners is to avoid using social media, but there are plenty of other entities that post private details (e.g., real estate purchases, websites reviewing psychotherapists).

Many psychotherapists have difficulty understanding the risks involved with online behavior (McMinn, Bearse, Heyne, Smithberger, & Erb, 2011). Personal and professional boundaries have become blurred due to the multiple ways that social media and the Internet provide for connection. Dual relationships, both sexual and nonsexual, are the most common complaint to the American Psychological Association (APA Ethics Committee, 2014). However, the ability to access personal (p. 159) information online does not support an increase in complaints for psychotherapists: Dual relationship complaints have been steadily decreasing since 2006 (APA Ethics Committee, 2014). The meaning of this statistic is unclear. As a society we are experiencing a shift in how we view personal privacy: Reality television, smartphones, and social media give us full access to the private lives of people. How does this shape a client’s experience with a professional? Actions that may previously have seemed “over the line” for a client may no longer be so in the information age. Psychotherapists need training and guidance about the new standards for dual relationships.

The mental health profession has been lax in addressing digital challenges other than telepsychology. Many therapists feared crossing unfamiliar ethical boundaries or were reluctant to investigate digital options without guidelines. The first formal ethical guidelines for technology in general therapeutic practice appeared in 2005 from the National Association of Social Work. Although they were vague and quickly became obsolete, these ethical standards guided practitioners who were willing to try using digital options in practice. The APA’s 1997 code of ethics briefly mentioned the need for ethics dealing with technology. The current revision of the code, while describing the need for due diligence when using digital solutions, does not set an explicit standard for technological boundaries or integration throughout practice situations. The most comprehensive ethics code to date is that of the American Counseling Association (ACA, 2014), which devotes an entire section to distance counseling, technology, and social media. This code can provide education for all psychotherapists.

APA psychologists developed 18 practice-specific guidelines for practitioners addressing a common area of digital practice, telepsychology. Telepsychology is the only guideline focused specifically on technology practices, however (APA, 2013). Guidelines for practice neglect current issues such as social media guidelines and the impact of the “digital divide” on practice populations (the digital divide is the gulf between those who have access to computers and the Internet and those who do not). Many digital immigrant clinicians are reluctant to explore digital options for themselves or their clients. This may be because they hold fast to their prior ethical standards, they lack interest, or they are anxious about the introduction of technology. However, without the guidance of the profession, psychotherapists may be at risk for committing Health Insurance Portability and Accountability Act (HIPAA) violations, facing dual relationship issues, or continuing to be reluctant to use technological tools.

Digital natives, on the other hand, grew up with 24/7 technology access. They make little distinction between online and face-to-face connections. These natives frequently rush to buy the latest gadget or app. The history of a digital native’s life is available online, sometimes from before birth if their parents were tech savvy. Privacy concerns of digital natives do not surface before young adulthood. New psychologists may worry about evidence of high school or college parties, extreme opinions, or other youthful behavior that exists online, whereas most digital immigrants do not worry about an inappropriate picture from college appearing in a Google search.

Older supervisors may be concerned about how they can serve as effective mentors for digital natives who are entering the field of psychology. But in reality the differences between the two age groups can benefit both. Younger clinicians can educate their supervisors on technological advances, and digital immigrants can provide a balance to the digital natives’ exuberance in using digital platforms. Together, these two generations can create the right balance of ethical technology use.

Technology Assessment of Families

Combining structural family therapy assessment with technology assessment provides a unique view of the functionality with clients. Technology is a thread of communication, or lack thereof, in families leading to enmeshment, engagement, disengagement, or a combination of the three (Minuchin, 1974). As technological practices are weaving their way into society’s attitudes and behaviors, a technology assessment is crucial for an accurate treatment plan.

Understanding digital behaviors can offer insight into the strengths and weaknesses affecting the client or family system. The time family members spend on their digital devices provides data about family engagement. Just as questions about chores or curfews reveal parenting styles, the boundaries on technology use need to be evaluated. Asking about the types of games played and programs used can offer a unique view into the client’s perceptions of violence or relationships. Inquire about social media outlets and numbers of followers or “friends.” What does the client’s online behavior say about him or her? Even cultural and generational perceptions of technology can cause underlying conflict within a family system.

(p. 161) Case Vignette

Sixteen-year-old Jane frequently used social media as a way to connect with friends and meet new people. She started having conversations with Ted on a new dating app. They decided to meet at the mall after a few weeks of texting. Jane felt she knew Ted very well. She considered him a friend and hoped it would lead to more. Ted brought two male friends with him to the “date.” As the group walked around the mall, Ted said he had left his wallet in the car and asked if Jane could lend him $100, promising to return the money at the end of their date. Jane, excited because he said the word “date,” took the group to an ATM and withdrew the money. Later, in the parking lot, the group of men pushed Jane down, stole her purse, and drove quickly away.

Jane was distraught but did not share the incident with her parents. She felt ashamed at being assaulted and robbed. She knew her parents would not approve of her meeting someone from the dating app. Jane’s mother approached her after dinner and said she had received an email that Jane’s bank account had reached the $500 spending limit. Jane had no choice but to share the traumatic incident.

Jane’s parents took her to file a police report, starting an investigation into the robbery. Jane needed to disclose every text with the detectives. Due to the trauma and embarrassment of the incident, Jane turned inward. The investigators found the responsible party, a group of 20-year-olds who were assaulting vulnerable adolescents. As the court date drew near, Jane would not go out with friends or her parents. School and work became her only outside outlets.

Jane’s parents insisted she attend a family birthday party at a skating rink in the mall where the attack took place. Jane became angry and unusually explosive trying to get out of going to the party. Her parents forced her to attend. Jane experienced her first panic attack at the party. Jane’s parents, while supportive of their daughter, did not understand her behavior or subsequent panic attacks. They decided to bring Jane in for psychotherapy.

Unemployed and seeking disability, the father spent most of the day participating in a popular role-playing game (RPG). If he was not on the RPG, he was playing Internet games with his 12-year-old daughter. The father spent most of his waking hours on the computer with his online friends. The amount of time he spent gaming caused a significant strain on the marriage.

Jane’s brother spent most of her time in the basement with their father playing video games or online playing a game creating environments out of cubes. There was no supervision regarding who contacted him. Many of the video games held adult ratings and centered around war or killing.

Jane used all the latest social media apps. Her followers numbered in the thousands. If not on social media, Jane would take part in her own RPG game. This online game catered to the adolescent fantasies of the popular genre of vampires, fairies, and other supernatural characters. Jane often ate meals in her room while she communicated online with friends.

In contrast, Jane’s mother did not like technology. She used the Internet only to pay bills and access her work email. She resisted smartphone technology and showed her five-year-old flip phone with pride. She became frustrated when discussing any technology, deferring to her husband as the expert. She tried to set up boundaries on technology use, but the father would undermine the limits and consequences.

(p. 162) Lessons Learned

A technology-integrated assessment led to an understanding of this family’s structure, subsystems, boundaries, and alignments (Minuchin, 1974). The family structure provided insights into the communication pattern with the help of a technology ecomap as a guide. Using a visual ecomap of tech behavior helped the family members understand the assets and deficits in communication and their relationships. A rigid boundary existed between the mother and the rest of the family. The father and his son were enmeshed, with no clear parental boundaries between them. They aligned their relationship to thwart the mother’s household rules. Jane had disengaged from the family. She created a different support system online, at school, and at work. Neither parent had any idea how Jane spent her time online or her activities outside of the home.

The therapist’s technology assessment identified many high-risk situations and communication problems within the family system. Dysfunctional behaviors may be intensified by technology, but technology is not the root problem. For a family that already has dysfunctional behaviors, an increase in stress can lead family members to use technology as an unhealthy distraction or addiction. The psychotherapist can make the family members aware of these ineffective communication patterns. Using qualitative and quantitative data about the family’s technology patterns offers a path to address the underlying issues of disharmony. This family brainstormed new boundaries with technology and how technology could be used to increase their family bonds.Not all families will present with upfront technology issues. The technology assessment does not take the place of a social history or clinical assessments. However, assessing digital behaviors can provide another level of understanding the complex communication within the family system.

Psychological Testing

Using the computer for personality testing is not new to the field of psychology. MMPI results were first interpreted using a computer system in 1962, when computers filled large rooms. Extensive research exists on the MMPI’s assessment and interpretation validity over the past 60 years. The use of technology for MMPI scoring meant a significant decrease in the amount of time spent by the psychotherapist doing calculations, time that can now be used to interpret the scores using clinician observations and client history. The MMPI can now be given online, prompting research into how technology can further benefit psychological testing methods.

The results from researchers’ studies of the reliability and validity of other online psychological tests hold promise. Study results show both an increase in dependable responses due to the anonymity the Internet provides and no difference in disclosure rates between online and in-person administration (Brock et al., 2015). The caveat with online psychometric testing is the lack of qualitative equivalence with online participation versus in-person delivery. Online assessment (p. 163) options used in private practice need vetting to determine if they are congruent with the nondigital ones. The therapist who chooses to use an online test that has not been not researched should be aware that there may be discrepancies in the results.

The Q-global web-based administration, scoring, and reporting site by Pearson offers 27 common used assessment tools, including the BASC-3 and the MMPI-2 and MMPI-2 R/F. Other test companies, such as Psychological Assessment Resources (www.parinc.com), also offer web-based administration of some of their tests. Recommendations for operating systems and browser requirements are standard with software usage. These tests can be administered in the office with ease on a tablet. Computer tabulating software has dramatically reduced the amount of time needed for results to be available to the clinician.

Technological Interventions

Digital tools can increase adherence to treatment for clients who are comfortable with technology. Multiple studies support the efficacy of computer and Internet-based approaches to training or practicing therapeutic skills. The capacity for long-term change using technological interventions is evident in self-monitoring and self-awareness, self-efficacy and motivation, and environmental awareness research (Runyan & Steinke, 2015).

Apps that have been developed for smartphones and other mobile devices carry promise for interventions across the clinical spectrum. Ecological momentary intervention (EMI) techniques represent an area fertile for research and development. These tools allow clients to record their thoughts, feelings, and behaviors and to be present in the moment for a clinical intervention without a psychotherapist being present. Using notifications, banners, and other types of reminders enhances the technique.

While there is research on the overall efficacy of the Internet and computer-based software, there may not be evidence supporting the efficacy of a particular app. Practitioners can evaluate EMI apps through their awareness of clinical guidelines. Self-monitoring apps designed to increase motivation may offer prompts for goal setting, affirmative self-talk, or self-reflective questions. An app addressing environmental resources may involve in-app chat rooms with other people working on similar issues or computer-generated role plays of situational triggers (Runyan & Steinke, 2015). Apps providing tracking mechanisms and goal reinforcement for positive behaviors may provide longer-term results, like their computer counterparts exhibit.

Many apps for personal or professional use are available from the U.S. government. The Department of Health and Human Services, Department of Veterans Affairs, the National Center for Telehealth and Technology, and the National Institutes of Health offer a variety of well-designed mobile programs that clients can access for free. They include telehealth tracking tools, educational forums, tools addressing psychological health, and videos on a wide range of health and mental health issues. Many government mental health apps provide empirical results proving the efficacy for the method, if not necessarily the app.

(p. 164) Apple or Android apps provide a range of resources, some free and others expensive; cost does not equate with quality. Before recommending an app as a digital tool, assess whether it will be suitable for a particular client and familiarize yourself with how it functions. Displaying confidence and providing clear instructions that build on the client’s technology knowledge will increase the client’s adherence to use of the app (Runyan & Steinke, 2015).

HIPAA Risks and Compliance

Use of electronic health records (EHR) can transform a private practice because psychotherapists can maintain client records in the office, at home, or on their smartphone. However, the availability of EHR systems across platforms increases the risk of HIPAA noncompliance. HIPAA standards represent one area of practice in which technology guidelines are up to date. The new expectations for HIPAA compliance fall not just on the vendor but on the practitioner as well (APA Practice Organization, 2013). EHR systems and HIPAA regulations may not be congruent with each other, especially if the EHR system is a few years old. Even if your EHR system states it is HIPAA compliant, this may not be the case: Compliance is merely a claim of the vendor and not a governmental certification.

The security of EHR has increased with the 2013 HIPAA revisions. EHR vendors must continually evaluate the security of their systems based upon 75 security controls. Not only is your practice’s EHR system under scrutiny, but each device you use to access the program needs a yearly security risk analysis. There is not one EHR system that is completely secure from a privacy threat. EHR vendors may state their system is 100% secure, but providers beware: Any technology is vulnerable to a person with the appropriate knowledge and an Internet connection. HIPAA regulators require evidence of due diligence for security, not an expectation of perfection. Maintaining physical evidence through updated policy and procedure manuals is considered best practice for documenting HIPAA compliance.

Each technological device used by providers comes under HIPAA regulations. Many smartphones and tablets offer a fingerprint scan for access, allowing an added measure of security. A stolen digital device is any therapist’s nightmare, but there are programs available that can purge the data on the device or disable it if it is lost. As long as the encryption on the phone meets the HIPAA security rules, clients do not need to be notified of a records breach. If the stolen device did not enable security protocols, however, all clients need to be notified of the violation. The HIPAA security protocol used to safeguard protected health information includes a password or fingerprint user authentication, a remote data wiping feature, disabling file share applications, use of up-to-date security software, deleting all data when exchanging devices, and not using public Wi-Fi networks unless the device has encryption apps for sending texts and emails.

One HIPAA threat that is often overlooked is the provider’s printer, copy machine, or fax machine. Every client record that is faxed or copied has a file on the machine’s drive. Disposal or repurposing of these machines requires special care to wipe the hard drive clean of records. (p. 165) Some companies buy old copy machines and faxes exclusively for their data. Add this precaution to your disposal policies to increase security and client protection.

Using apps in a private practice requires diligence. The confidentiality risk for psychotherapists using mental health apps in their practice is unknown. HIPAA regulations state that apps should be evaluated for HIPAA compliance only if they store personal health information or offer a method of communication between the provider and the client (APA Practice Organization, 2013). These guidelines provide clinicians with a wide opportunity to use apps.

Electronic Health Records

Client software has come a long way from the initial Access or Excel database programs. Software programs that track protected health information not only minimize your risk for HIPAA violations but can also offer benefits that can cut your time as a practice manager. Basic features include scheduling, simultaneous backup, DSM5 and ICD-10 connections in treatment notes, and electronic billing for insurance companies, providing a seamless connection between psychotherapist, client, and financial matters. Mobile apps offer clinicians a connection to their client and practice content anywhere and anytime. Some software includes an app for client use in scheduling and communication. These apps offer a way to communicate with a client within a HIPAA-compliant, encrypted system, and the communication automatically becomes part of the client record. Pregenerated voicemail calls, emails, or texts can be sent to clients as a reminder of upcoming appointments, minimizing no-shows.

Psychotherapists can choose from a number of private practice enhancements. EHR software can provide a dictation method for writing progress notes as well as tracking client outcomes for research or insurance companies. Some programs allow for personalization of online forms so they can be consistent with the system already in use. A single system can allow for alternative methods of marketing your practice and tracking your referral base.

EHRs vary in their offerings and efficiency. Free trials can expose therapists to different EHR elements. Defining needs versus wants can help you decide how much money you want to spend. A hidden cost is customer service help, so ask how much free help the company provides in implementing and maintaining the EHR.

The American Recovery and Reinvestment Act of 2009 offered a medical records stimulus, but it was not available to psychotherapists in private practice. Psychology and social work organizations have been working on adding these professions to the list of eligible providers. A bill, introduced in 2015 and still awaiting action, would include psychologists as eligible professionals who could apply for compensation for using EHR in their practice (H.R. 2646, 2015). Only psychologists billing under Medicare would be eligible. This bill would not only offer financial perks for EHR development but would also introduce a mandate with consequences if EHRs were not adapted.

(p. 166) Informed Consent

Using EHRs or any other technology in your practice requires a change in your informed consent forms. A consent form should contain specific details. Areas to include on the form (and in discussion with clients) include the following:

  1. 1. Appropriate boundaries for texting or cellphone use

  2. 2. Explanation of how technology will be used in and out of sessions

  3. 3. The risks associated with use

  4. 4. Cost of technology for the client

  5. 5. Safety considerations

  6. 6. Security and confidentiality

  7. 7. Risks of using different types of technology

  8. 8. A list of all parties who will have access to the client’s EHR (Jones & Moffitt, 2016)

This information can be integrated into your current consent form or can be given on an additional technology-specific consent form. A separate form can highlight the importance of each area in the digital consent. Specifying the boundaries of social media requests can clarify “friending” on Facebook, connecting through LinkedIn, or possible conflicts of interest in other online behavior. An upfront explanation of these social media limits will decrease confusion before, during, and after the clinical relationship. An example of a social media policy that clinicians may adapt to their own practice may be found at http://drkkolmes.com/social-media-policy/.

One critical element in confidentiality practices is the understanding that education on app safety and risk should not end when the client signs the consent form. Each type of technology used in sessions needs a benefit and risk review. An example of this would be how a “widget” appears on the screen. If a client is in a domestic violence situation, there are apps offering emergency services to victims. People often share phones with family members, so these apps increase the user’s safety by using an innocuous-appearing widget likely to be of no interest to the perpetrator.

Client and psychotherapist alike should evaluate the security of all devices they use to prevent confidentiality gaps. Many clients do not know as much about privacy and security as the psychotherapist. If clients record vulnerable data on an app, the results of such disclosures need to be explored. Children or spouses may inadvertently open the app, exposing them to confidential material. A worse situation is if the phone is lost or stolen. Clients can make informed decisions about what they record once they understand the consequences. Many options exist to encrypt and protect data, minimizing the accessibility of apps holding sensitive information. Apps with these security measures add a necessary level of reassurance.

Marketing Options

A diverse online marketing strategy can save time and money in soliciting opportunities for a private practice. Websites are common tools that psychotherapists use for promotion. A website (p. 167) serves as an introduction to the therapeutic process; what does your website say about your practice? Well-developed website content helps readers understand why they should come to your practice. When developing your own practice website, view the websites of different private practices similar to yours in terms of size, population, and services offered. Identify which features draw you in or make you want to leave the page (but keep in mind the content is directed toward clients, not other professionals). Ask advice from different people and evaluate their opinions about your content. Websites can act as a focal point for referrals. Presentation materials, email signatures, promotional items, blog posts, and business cards all should carry the website link. Add downloadable links of consent and intake forms to begin the development of a client–psychotherapist relationship.

The use of social media sites for networking can create challenges for psychotherapists. Some private practices use Facebook to advertise their services. Facebook is a free and easy alternative to developing your own website. A “page” describes your services and provides a way for people to “like” and follow your content. But if a client chooses to respond to a post on the page, what does this mean for his or her privacy? How many of his or her friends now know the client is seeking services at the place described on the page? What if a person posts a suicidal or homicidal thought on the page? Consider these issues before you use unregulated social media options for advertising.

A practice thrives from a strong referral network. If you write a blog addressing ways to present information about mental health, you can market it to online psychology magazines, it can serve as subject matter for groups such as LinkedIn or Google plus, and it can earn you a reputation as a content expert. If writing is not an interest, you can use a blog to share other people’s articles on a specific topic. Decide on a blog that fits your professional interests and passions, because if you become bored with the content the blog will quickly meet its end.

As a new clinician in practice, I joined a private online community in my area that provides resources, education, referrals, and problem solving. Many referrals are generated in this manner. If this type of community is not available, develop and become the moderator of one in your area. Professionals will remember those psychotherapists who offer advice to a problem or a referral outside their area.

Online Risk Management

Being aware of online privacy and security is critical to maintaining professionalism with clients. Using your name online can allow you to be found by anyone with a search engine. Years ago I wrote a book review on Amazon, not understanding the implication of my post at the time. It appeared whenever I Googled my name. I could not delete it. As a professional, I did not want this judgment to be accessible for clients to view. The review didn’t contain any negative information, just my opinion, but I was still uncomfortable knowing any client could see the content. The ability to make comments “private” this past year allowed me to erase the comment from search engines, much to my relief.

Ignoring social media and its impact is no longer an option. Clients actively participate online, often with negative results, and understanding the impact of your behavior online is fundamental (p. 168) in balancing private versus professional information. It seems every week there is an article about an inappropriate tweet, picture, or comment that went viral, ruining someone’s personal or professional life. Reputation is not easily earned and can be tarnished with a single misstep.

One recommendation for risk reduction is for psychotherapists to Google themselves regularly, both on the web and through images, to find out what information is public knowledge. You want to know what a client will find.

Social media allows for the documentation of every developmental stage. Tech-savvy parents now establish Facebook pages as virtual photo albums for their infants. Every detail of life is recorded, including possibly unsavory high school and college behaviors. Diligent digging can unearth Twitter conversations with friends or Pinterest boards displaying your hobbies and dietary preferences. Searchers can locate every place you visit with your smartphone, including every stop you make on your way home from work.

As a psychotherapist, an unprotected personal social media account is an ethics issue waiting to happen. Boundary issues may occur with no notice. Facebook updates the types of searches it performs to increase choices for users. One new feature recommended a line of faces you might want to “friend.” After a few weeks of use, I found three client pictures on my page waiting to be “friended.” I realized that Facebook accessed my contacts through the email account I was using. Since I check my business Gmail most often, I tied them together. And I realized that if I was seeing clients on Facebook, they were seeing not only me, but any picture I chose to use as a profile. I scrutinize the privacy settings on all my accounts, but with the advent of new ways to use data, privacy breaches are inevitable. I cannot predict the next way privacy can be an issue, but I can respond with ethical behavior (if I am fortunate enough to become aware of the problem). My response included changing the email address associated with all my social media accounts and carefully choosing my profile photos. A technology upgrade is a signal for psychotherapists to search for risks in new developments.

You can safely assume that your clients will Google your name. They may just be looking for your address, but all the information under your name will appear, ranging from your address and phone number to how much you paid for your house. A colleague of mine searched for her unusual name only to find it also belonged to a famous porn star. Awkward Internet items found on your name search fall into the category of “it’s good to know in case it comes up.” On one Internet search I discovered a link to my professional license, and the brief description stated my lack of license renewal. I immediately called the department of professional regulation. While I was on hold, I began clicking on each link to identify the issue. I discovered the site referred to my LSW, not my current LCSW license. If a client viewed my inactive license, I would now have an explanation. Googling yourself on a regular basis will let you know when your personal information becomes a professional liability.

Conclusion

Technological advances will continue, and therapists can no longer ignore the impact of technology on personal and professional behaviors. While some professional mental health organizations (p. 169) provide technology protocols, the level of detail for a psychotherapist’s protection is scant, so the responsibility for maintaining boundaries within a private practice falls upon the therapist. Be open to participating in conversations and trainings about technology and practice that provide evidence-based interventions and protections for you and your clients.

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