The Healing Arts

As a professional, state licensed mental health therapist and board certified art therapist, I am duty-bound to protect the privacy of my clients, and guard their safety. Posting video of a child's therapy session, even with parental consent, is unethical and places the child at risk, no matter how small. While parents might have signed off on it, the clinician should know better. I would also question the rational of posting ANY video at all, for what is purely commercial purposes. Sadly I think that the increasing technology has blunted the critical thinking of some of my colleagues: just because 'everyone is using it' does not make it appropriate or ethical or safe.
Therapists having 'fan pages' is, is my opinion, self-serving if not grandiose. Promote your practice on your website and attach a link where ever you want. But if you do use a social networking site or website, please remember that your first duty is not to your business but to your clients.

From a cyber-culture perspective, as I understand it Facebook is a world of uber-narcissism. So everyone becomes a star in their own movie so to speak. It does get a little strange when therapists cannot grasp this perception, however. I once served on a national mental health board of directors and headed a task force for impaired therapists; this would have been an issue we would have brought to the attention of this practitioner.

Our ethical codes in mental health are fuzzy about cyberspace, but we all know that ethics are much more complex than codes or regulations. I agree with you, IMHO, practitioners should know better than to post any raw footage of an actual client session on the Internet in a social networking platform. We all know-- or should know-- the inherent limits of informed consent.

Cathy,

I like your post and it brings up a lot of important issues. I'm a private practice therapist who has opted to create a Facebook fan page and I see it as both marketing and a way to share content with consumers and other mental health professionals. It is an adjunct to my website and blog and it allows people to share my writing with others in their friend networks.

I disabled my fan page wall so that people are not posting their own content on my page. I also do not have clients as fans. If a client were to become a fan of my page, I would discuss it in treatment and talk about having them remove themselves for confidentiality concerns.

I've also been fairly immersed in the ethical issues related to social networking for therapists and wrote my own post for mental health professionals who want to use Facebook, which can be found on my blog.

I agree with you that therapists should not be using their Facebook pages to post client material at all. Even with client consent, I think that opens up a huge can of worms. We can empower our clients to post their own content in their own online spaces, if that seems therapeutic, but I don't think posting it on our sites is wise or protective of confidentiality.

I just wanted to chime in and say that I do think there are ways to be ethically mindful and still participate in the evolving online culture, but I agree that there are important considerations to be made.

Thanks for your post!

Cathy, I wrote a response to your article on my blog:

http://www.lizbeck.net/2009/07/22/facebook-fan-pages-for-therapists/

I wanted to add to my thoughts after reading the above comments. I certainly agree that acquiring consent for the purpose of advertising one's practice is overstepping the ethics of our profession. As mental health professionals we must be honest with ourselves, our clients and their families, by not trying to pass off an advertisement as an attempt to educate the lay person about art therapy and its benefits.

Thank you for bringing this topic to our attention because you're right- somehow ethical codes get fuzzy in cyberspace and having an open dialogue amongst professionals is a step towards clearing the haze.

One last thing-

Here's an interesting article about a tool that's been created allowing messages to self destruct after a certain period of time, so that things that are posted online will not necessarily be immortal:

http://www.sciencedaily.com/releases/2009/07/090721113309.htm

By the way, if folks here are interested my post on Managing Facebook for Mental Health Professionals, you can read it:

http://drkkolmes.com/blog/2009/06/08/managing-facebook-as-a-mental-healt...

Also, another consideration in regard to Facebook pages, whether they are fan pages or regular profiles that allow client postings is that there are legal and ethical risks when you invite clients (or future clients) to interact. I highly recommend the following reading: Recupero, Patricia R., Legal Concerns for Psychiatrists Who Maintain Websites. Psychiatric Services, April 2006, Vol. 57. No. 4, 450-452.

Here is a link to the Recupero article [pdf] http://snurl.com/ntq74

And thank you to Liz for the fascinating link to the Vanish application. That was news to me!

There may be a way to get pages on the Internet to vanish, but since I posted this column, another aspect came up. I was able to download the films using the Safari browser [a common and easy technique], grab all the client art images, and capture all the screen shots. While these are taken out of the original context, it brings up yet another issue-- an unscrupulous person could start to post this stuff anywhere on the Internet, including YouTube, the mothership of video social networking.

I keep learning -- and thinking of new twists to this issue. I want to thank everyone for taking the time to write [I have a box load of emails, too], you are helping me to think more deeply and with greater understanding.

Cathy
Cathy Malchiodi,PhD, LPAT, LPCC

I've happened to come across a great deal of therapist activity online that would seem to cross ethical boundaries, and Facebook Fan pages for a private practice are the least of it. My art therapist has a Fan page on FB for her business, and I wouldn't think of adding it, but a therapist simply putting something like that out there is bothersome to me. Who would be likely to want to Fan a business page? The consumers of those services, of course...and when it comes to therapy clients, this is an invitation to potential boundary problems. Not allowing a client to Fan a page could feel like rejection, and allowing it could pose a threat to privacy. It seems like a poor choice to out one out there at all.

Even with informed consent, posting videos with clients on FB should be avoided. Clients with boundary issues may not be able to say no to his/her therapist, and children should not be exploited in this manner even with parental consent. I think it puts clients at risk of emotional harm.

FB creates very permeable and strange boundaries, and many, many people, including therapists in practice in my area have wide open FB pages within my networks.Even in a network for a medium-sized city, the social inter-connections between people can be surprising. My therapist "friended" one of my friends one day, and I was a bit horrified.

Additionally, there is a blog by another local art therapist who does work with very elderly clients and clients with brain damage. She posts photos of their work. One of those clients is deceased. I could be wrong, but I doubt she is taking the time to obtain consent to post the work of 90-something year old clients, deceased clients and brain-injured clients before posting them to her blog. From what I understand, written consent is required even if the client is anonymous.

I think these are important topics to be discussed, and I am glad that there are people in the field raising these issues.

I too am so glad you are raising and clarifying these issues. I think your point about children and consent is well-taken; in the case I am referring to, I do not believe the therapist is acting in the best interest of the child. I think the therapist is acting in the best interest of the therapist, plain and simple. Clients should never be "billboards" for a therapist's practice-- at least in my humble opinion.

Again, I very much appreciate your cogent observations!

I think this is a very important issue to bring to light and I agree that one's on-line presence is subject to scrutinization and we should all be very careful about the online "crumb trail" we leave. I am a psychology major currently in the application process for graduate school. As a future therapist, I realize that the internet is a very powerful tool and should be used with discretion and in a professional manner when used for professional networking. Like it or not, unless you choose to live somewhat "off the grid" and avoid participation or subscription in online social and professional networking and organizations, anyone and everyone is subject to being put under the mircroscope. I post every piece of content and commentary with the full cognizance that anyone at any time may read what I've posted. Realistically, I feel at this point, that pool is small, but I still realize any random search can put my info. in front of anyone's eyes.
As a future professional, licensed therapist, I know that I will not post information about my practice or clients on social networks such as FB. I believe the privilege of the client/therapist relationship should be greatly protected and respected. It is very important as a means of self-care and personal privacy to set rigid boundaries of just how much personal and/or professional information others are privy to. There has to be a clear deliniation, in my opinion, between professional life and private life, in order to protect the client and the therapist.