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(p. 700) Practicing in the Era of Social Media 

(p. 700) Practicing in the Era of Social Media
Chapter:
(p. 700) Practicing in the Era of Social Media
Author(s):

Jeffrey E. Barnett

and Keely Kolmes

DOI:
10.1093/med:psych/9780199845491.003.0135
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Social networking sites are becoming a ubiquitous aspect of life for both psychologists and consumers of professional services. Social media sites provide a means for interacting and sharing information with others via the Internet. Examples include Facebook, MySpace, LinkedIn, and Twitter, and many others. Social media permit individuals to share information with others in ways never before possible. These social media have significantly impacted how many individuals form, develop, and maintain relationships in their day-to-day lives.

Social media sites such as Facebook and MySpace allow users to create free accounts that enable them to post and share material online that includes personal information, photographs, videos, and links to other Web sites. Participants may also communicate with others by posting messages that others may respond to and by participating in blogs (online journals which may also allow comments by other users on issues relevant to a particular topic). Those who create an account grant access to other individuals by designating these individuals “friend,” “contact,” or “follower” status, permitting access to their posted material. While these sites offer a range of security settings that users may adjust to prevent unauthorized access to materials they post online, “friend” status generally permits greater access to material posted on one’s online profile. For example, photos, news stories, or Wall comments can be accessed that would remain otherwise hidden to those who do not have friend or contact status.

Widely Used Social Networking Sites

Founded in 2004, Facebook had over 175 million users in 2009 but has quickly grown to be the most widely used social networking site worldwide. There are now over 845 million active monthly users who post over 2.7 billion “comments” and “likes” on the site each day. Over 161 million of the active users are from the United States and 60% of all web users are reported to be active users of Facebook (ITProPortal.com, 2013). Users on Facebook share status updates, photos, videos, and news items and also comment on other users’ “Walls.” More recently, Facebook has partnered with other sites such as Youtube and The New York Times so that users have the ability to notify friends on Facebook of other online content viewed and “liked” on these Web sites.

LinkedIn is similar in format to social networking sites such as Facebook, but it is designed as a forum for professionals to share information with each other and to develop an online professional networking community. Many individuals use LinkedIn to make professional contacts, to seek employment, to recommend other professionals, and to grow their businesses. Some individuals also connect socially on LinkedIn with their friends. Many users are also now (p. 701) connecting their LinkedIn updates to sites such as Twitter, integrating and sending this content to multiple sites. LinkedIn has over 100 million active users with reportedly more than 1 million new users joining each week (LinkedIn, 2011).

Twitter is a communications platform that utilizes SMS text messaging on cell phones and other electronic devices that enable users to share brief messages of up to 140 characters in length (called Tweets) with users in their online network. Those in their network, called “Followers,” automatically have access to the archive of tweets posted by that individual. Twitter offers individuals the ability to quickly share information with others, Direct Message (DM) users who follow them, and to easily keep in touch. Founded in 2006, Twitter is presently the third most widely used social networking site and continues to grow rapidly (Barnett, 2010).

Personal Versus Professional Use of Social Media

Increasingly, psychologists and consumers of psychological services will each utilize social media as important ways to communicate, share information, and conduct relationships with individuals in their personal lives. While teenagers and young adults may have comprised a large percentage of social media’s initial users, social networking sites are now used by millions of individuals across the life span. It is highly likely that many individuals who seek professional assistance from psychologists, and psychologists themselves, will maintain an online presence and actively use one or more social networking sites in their personal lives.

Before posting or sharing personal information via social networking sites, psychologists should exercise some forethought and caution. It is important to consider the possible effects or impact on clients should they access personal materials posted by a psychologist. Not all materials shared with friends and family would be appropriate for clients to access. Examples to consider include the following:

  • Having clients view photos of you on your recent vacation, such as of you lying on the beach in your bathing suit. What if the client is struggling financially and the photos clearly show you at a very expensive resort?

  • How might a client who is dealing with fertility issues in treatment be impacted by viewing photos of you joyously holding your new child or grandchild?

  • If a client’s spouse recently died and she is all alone, could that client be adversely affected by viewing photos of you spending a holiday surrounded by a large and apparently very happy extended family?

In considering these and similar questions, psychologists should exercise caution when making decisions about what they should post online and who should have access to it. While each individual has the right to post online whatever they wish, psychologists have a responsibility to consider the potential impact on clients who access these materials. They also have a responsibility with clients to only act in ways that are consistent with their clinical needs and interests. This makes granting clients unrestricted access to one’s personal social media profile a significant ethical concern.

When utilizing social media such as Facebook and MySpace, it is important to first research and carefully consider the privacy policies of these sites and to ensure that the appropriate security settings are used so that unauthorized and unintended access to one’s profile is prevented. Yet even when using the highest security settings, those that only permit a preapproved subset of “friends” to access one’s online materials and communications, it is important to remember that “friends” can share or repost materials from your profiles onto theirs. Once information leaves your pages or profiles, you lose control over who may access it. Another important consideration is that messages exchanged between therapists and clients on these sites are not secure and may become a part of the legal record.

“Friend” Requests from Clients

Frequently, clients will search social networking sites they belong to in order to see who they know who may have a profile on that site. (p. 702) Those who share cultural affiliations with their psychologist, such as ethnicity, sexual orientation, religion, or disability status, may find themselves more likely to have other friends and contacts in common on these sites. As a result, they may then send their psychologist a “friend” request. This is an online message used to request “friend” status. Friend status would permit the client greater access to your online profile, as well as minimally indicating a visible connection to you online. As a result of this connection, depending upon your privacy settings, the client may view more of your online information and the materials you have posted, as well as communicate with you online in this new online “friend” role. This new access may also permit the client to interact with others in your life who also post or comment on the content shared on your profile page. Such friend requests create a number of challenges for psychologists. These challenges include issues about confidentiality, boundary issues, and multiple relationships. Patients who gain access to your network of friends and contacts may come to discover the identities of others who have been or are currently in your care. In addition, they may attempt to establish relationships with those in your network. This can potentially compromise client confidentiality and create various other boundary dilemmas.

A number of relevant boundary issues must be considered before accepting a friend request from a client. The first is to consider how being “friends” will impact and alter the professional relationship. Most psychologists would not typically serve as a client’s psychotherapist while simultaneously engaging in a social relationship or friendship with the client. Most clients understand that their psychologist is not their friend. Typically clients will not initiate a social relationship with their psychologist by inviting their psychologist to lunch, to go shopping together, and so on. Furthermore, most psychologists would not introduce their clients to their friends or family or encourage these individuals to engage and interact with one another. Yet, in the online world, communicating and sharing information with others through social media sites is done so frequently that many individuals may not even consider it as a multiple-relationship issue. They may simply just consider it a normal part of all relationships.

Psychologists, on the other hand, trained in the ethics of boundaries and multiple relationships, understand the need to generally limit contact with clients to our professional interactions. Engaging in intimate sharing from our personal lives holds great risk for adversely impacting the professional relationship because it erodes professional boundaries and jeopardizes the psychologist’s objectivity and judgment. Furthermore, such sharing can alter the professional relationship for the client, creating expectations for increased mutuality of sharing and possibly even contact outside of therapy.

One option for psychologists who participate in social networking sites to consider is to have two separate profiles: one that is professional and one that is personal. The professional profile would include practice-related information such as announcements about recent publications or scheduled workshops. Photographs of one’s office, of the psychologist, and of office staff could be included. Clients would be granted access to this profile or page. The personal profile, however, would not include any practice-related information, would only include information and materials from one’s personal life, and would be accessed only by those with whom the psychologist has a personal relationship.

Self-Disclosure

One important boundary in all professional relationships is self-disclosure, the sharing of personal information with a client. Zur (2009) highlights several types of self-disclosure that may occur. These include deliberate self-disclosure such as when a psychotherapist shares a personal experience with a client to assist the client in dealing with a difficult issue, but it should be motivated by and relevant to the client’s treatment needs; unavoidable self-disclosure may include client observations of a psychologist’s age, gender, ethnoracial identity, visible disability, and for those who wear a wedding ring, one’s marital status; (p. 703) and accidental self-disclosure, which can occur when a client sees a psychologist with his or her family in a social or public setting.

Psychologists participating in social media must consider how their online sharing constitutes a form of self-disclosure for those clients who may access the psychologist’s online profile and materials. Should clients be granted access to a psychologist’s personal information online that the psychologist would not ordinarily share with clients in person? For example, if a psychologist would not bring a family photo album to work to share with clients in session, how could giving these clients access to such material online be considered ethical and appropriate? Psychologists must also keep each client’s best interests in mind and consider the possible impact of inclusion in the psychologist’s personal life on the client clinically.

Integrating Social Media into Treatment

Granting clients “friend” status creates an online secondary relationship with all the sharing of personal information mentioned earlier. While it can be seen as inimical to an appropriate therapeutic relationship, there may be times when clients want to share their online materials with their psychologist. Rather than “friending” and accessing the client’s materials independently, it is recommended that the review of the client’s online materials be done as part of the treatment relationship. Thus, the client could log in to a computer in the psychologist’s office (the client can bring his or her laptop computer to the session, use the psychologist’s;, or access this material with his or her smartphone) and then together, client and psychologist could review the materials. This would be most appropriate when a client wishes to share his or her writings, artwork, photography, and the like, with the psychologist. Viewing them together in session helps keep appropriate clinical boundaries in place and enables the psychologist to process reactions to sharing with the client as they occur, helping to integrate the viewing of the online materials into the client’s ongoing treatment.

Various social media may also be effectively and appropriately used for providing treatment. There are a range of software applications (apps) and social media platforms online that are well suited for integration into ongoing treatment. Some apps allow clients to track their mood and chart automatic thoughts; others give them the ability to gain social support for new, preferred habits and behaviors. Psychologists should educate themselves about these applications on an ongoing basis (new ones are continually developed) and consider their use as an adjunct to in-person treatment. They should also discuss with their clients the privacy implications of sharing this data with others. An example is Mood 24/7 (available at https://www.mood247.com/), an online application that sends registered users periodic prearranged text message reminders and allows clients to submit mood ratings to this site using text messaging on their cell phone. The site then records and tracks the ratings, which can be accessed by the client and the psychologist. For clients struggling with depression or bipolar disorder, for example, having access to changes in mood ratings in real time can be a great enhancement to ongoing in-person treatment.

Establishing a Social Media Policy

Based on all of the issues addressed earlier and in keeping with the requirement that each psychologist engage in a comprehensive informed consent process beginning at the outset of the professional relationship, it is recommended that each psychologist who has an online presence develop and share with each client a social media policy. As is highlighted by Kolmes (2010), each client should be informed of the psychologist’s use of e-mail, blogging, and social media, how various platforms may be utilized in treatment, the psychologist’s “friending” policies, and whether (or when) the psychologist uses search engines to supplement assessment or treatment. A sample social media policy that may be downloaded, modified to fit one’s particular social media practices, and then used in one’s practice is available online at drkkolmes.com/for-clinicians/social-media-policy/

(p. 704) Psychologists utilizing social media should do the following:

  • Consider establishing separate profiles for personal or professional use.

  • Understand the privacy settings of various social networking sites they use.

  • Be mindful about what personal content they share on sites, understanding that others may share or forward this information.

  • Consider the confidentiality and boundary risks inherent in accepting clients’ friend requests.

  • Carefully consider whether they wish to allow comments by others to be posted on any professional blogs they maintain.

  • Develop a social media policy for their practice and share this with all clients.

References and Readings

Barnett, J. E. (2010). Psychology’s brave new world: Psychotherapy in the digital age. Independent Practitioner, 30(3), 149–152.Find this resource:

    ITPortal.com. (2013). Facebook releases usage statistics: 845 million users, 2.7 billion daily likes and comments. Retrieved April 25, 2013 from http://www.itproportal.com/2012/02/02/facebook-releases-usage-statistics-845-million-users-27-billion-daily-likes-and-comments/

    Kolmes, K. (2010). Developing my private practice social media policy. Independent Practitioner, 30(3), 140–143.Find this resource:

      LinkedIn. (2011). About LinkedIn. Retrieved February 2013, from press.linkedin.com/about/

      Recupero, P. R. (2006). Legal concerns for psychiatrists who maintain websites. Psychiatric Services, 57(4), 450–425.Find this resource:

      Younggren, J. N. (2010). To tweet or not to tweet, that is the question. The Clinical Psychologist, 63(2), 18–19.Find this resource:

        Zur, O. (2009). Psychotherapist self-disclosure and transparency in the internet age. Professional Psychology: Research and Practice, 40, 22–26.Find this resource:

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