Tweeting has become routine for many, but psychologists and other mental health professionals do so at their peril.
Psychotherapists who use social media outlets like Twitter might find themselves forced to navigate previously uncharted waters, and caught between contradictory personas. Common pitfalls and the questions they raise include: Is it ok for therapists to communicate casually? To opine or even joke about topics relevant to pop culture? And what about mental health? Does the discussion of serious topics on a public forum seem irresponsible or cavalier? When therapists decide to use social media channels like Twitter, how should they respond to followers who say negative things or complain about them?
For the first time in history a proliferation of social media outlets promises apparent instant access to mental health professionals. For those who don’t already know, Twitter works like this: anyone can open an account. Users write a brief factual paragraph and pair it with a photo or avatar. Tweets are similar to e-mail except they are limited to 140 characters—plus, they are not private; anyone who follows an account is privy to the Tweeter’s communications. Tweets can also be sent to a particular environment by using a hashtag, the designated symbol “#,” and then spelling out the place they wish the tweet to appear, for example “#psychoanalysis.” Searching that environment will display recent tweets on related topics. Professional organizations, educational analytic institutes, and even therapists themselves use Twitter to post notices of talks, meetings and publications to their followers, as well as to anyone else who enters hashtags relevant to psychology or analysis. Of course they have other things to tweet about. And therein lies the problem. And the contradictory personas.
There are many possible difficulties that can occur when private topics are transmitted publicly. So why would professional organizations, institutes, and practitioners send public missives accompanied by personal photos? Some see Twitter as offering a spontaneous and fun way to communicate. Others find in it an on-line community and referral network. Many use it to promote books or blogs or boost a public image.
But what about the other side of the coin: psychologists, psychoanalysts, and other therapists must complete years of training, during which they learn to respect patients, value privacy, and protect personal boundaries. Licensed professionals are bound by a moral and ethical code—and if our goal is helping people, alleviating their pain or fostering insight on matters most intimate and private, then chatting publicly with strangers about private matters seems counterintuitive, if not a bit unreal.
Thinking along these lines it becomes obvious that the usual ways of professional comportment would not serve to govern the therapist's interactions on Twitter. If we are trained to listen, and listen deeply for remnants of what had gone on in the past, to tune into how its artifacts remain alive in the present, and to pay attention to whatever might be going on in the room at any given moment with a patient, that's certainly not the way we roll on Twitter. Helping others to develop insight into their psyches and come to a place of acceptance of all aspects of the self is often a jointly held goal in work with patients; our interactions reflect this mutual expectation and clinical arrangement. But on Twitter it is different. What must therapists do when approached for advice or counsel or when confronted with a stranger’s feelings? What is appropriate behavior for professionals who interact in the Twitterverse?
Top of the list: mental health professionals should never criticize or mock those with psychiatric problems—and while this sounds obvious, it is worth mentioning that social media and snark seem to go hand in hand. The zeitgeist is to take swings at others; cruelty and humiliation sell. Despite the public’s penchant for below-the-belt attacks, it seems most responsible to tweet about non-intimate matters in ways that are respectful in language and tone. Even so, this basic guideline falls short of addressing other possible inconsistencies between the therapist's personal and professional personas.
Psychotherapists who blog are particularly susceptible to requests for advice and similar challenges to their clinical role. One recent exchange on Twitter illustrates the tension between personal and professional: I had posted a link to something I had written for a New York City newspaper; a post in which I argued that a character on Mad Men suffered from an internal fragility that caused him to flirt with sociopathic behaviors such as: stealing another person’s identity, frequenting call girls, lying to his long suffering wife, hiding money from her, and engaging in serial dalliances. I concluded that the TV couple seemed headed for divorce. In response I received the following tweet from a man with whom I had previously exchanged pleasantries. He wrote with a friend on cc: “I’ll bet Dr. Newman is divorced. “I think Dr. Newman hates men.”
Though this man appeared to be communicating something important to me, it was clear I was not his analyst or therapist. I wasn’t there to make interpretations, and I definitely did not want to respond in any way that would seem rude or unempathic—this was supposed to be fun, after all. I joked, “Not divorced but will be if I continue to tweet at odd hours of the night.” The man responded that he was going through a divorce, and had been through a painful time. I wished him luck with this difficult situation.
Another man, tweeting anonymously as a famous fictional character, asked me several times to disclose my fee, and inquired about making an appointment with me. Knowing from his bio that he resided in another country, I asked whether he might be interested in a referral; would he like to meet Dr. Freud?---though in my office such questions about fees and finances and requests for appointments would be treated differently. I certainly am not in the habit of referring people to the long deceased father of psychoanalysis, after all. But while money and fees are understood to have significant meaning and offer insight into an individual’s psychology, when it comes to the Twitterverse, such matters are all in good fun.
On another occasion a female tweeted to me in the middle of the night, asking for advice about how to handle a troubled relationship. Though I would have interpreted a late night call to my office, I did not respond in this manner to a request made on twitter. I could see that she needed to talk to someone, so during the following day I tweeted that I could not give advice over the internet, and asked whether she had a therapist. Not surprisingly, she did; she told me she had already made an appointment.
People in my field have been criticized for offering gratuitous interpretations and for analyzing people in social situations. Sometimes we are accused of lacking in spontaneity and of overthinking everything and anything. So what to do when strangers communicate with you in ways that might be meaningful when they occur between analyst and patient, but are generally represent harmless interactions outside of the consulting room? The challenge of being a psychologist on twitter is to figure out how to retain a professional demeanor but not act intrusively or callously—in other words how to engage in an authentic manner without making interpretations or hurting anyone’s feelings.
Psychotherapists using Twitter might find it helpful to follow certain basic rules of thumb: never tweet with patients. Instead of following patients or responding electronically, encourage them to bring all matters directly to the office. It is also a good idea to refrain from tweeting about personal things which can be difficult for others to hear (does someone struggling with infertility really want to see a picture of her therapist's toddler? It is usually more helpful to be able to discuss the issue and work with it in the office a therapeutic way). When asked for advice on Twitter it is better to suggest making contact with a licensed professional in a treatment, not social media, situation. And, as previously mentioned, those in behavioral health fields should never be critical or mock patients or anyone struggling with emotional problems.
Many mental health professionals continue to shy away from social media avenues as they are unsure how to best use them. Twitter can be a useful tool for those wishing to build practices, expand referral networks, or promote academic and other kids of writing. The trick is to figure out how to best navigate its challenging waters.