I spoke last week to a group of graduate students about the clinical and ethical issues that arise when using social media. With emails, Facebook and Twitter, the boundaries between a psychologist's personal and professional life is becoming murkier. The American Psychological Association has offered little if no guidance on such technological topics, leaving most of us to navigate these shifting boundaries on our own.
Here are three common ethical quandaries involving social media that are probably familiar to most psychologists:
To Google or Not to Google
Before search engines like Google, psychologists tended to rely exclusively on a client's self-report when formulating their clinical impressions and making diagnoses. Now psychologists have at their disposal unlimited amounts of information on their clients' personal lives. Likewise, clients have access to personal information about their therapist. With a push of a button, a curious client, who is so inclined, can figure out their therapist's marital status; whether their therapist has children; how much their therapist purchased their last home for; and what their therapist's political affiliation is. Such information is regarded as part of the "public record" and available to anyone who has access to the Internet. However, just because such information is available does not mean that we as psychologists should be accessing it.
There are two ethical principles psychologists should consider when deciding whether to Google a client. The first is in keeping with the APA ethics code and is predicated on the idea that our primary responsibility as psychologists is "to do no harm" to our clients. Second, as psychologists, we should always be asking ourselves whether searching for information about our clients truly falls within our professional role as their therapists. In the case of online searches, personally, I have made it my practice never do so to satisfy my own personal curiosity. However, I might consider doing an online search on a client if I believed the information was needed to prevent him or her from harming themselves or someone else. Under such circumstances, it would be my practice to disclose this information to the client as soon as possible and provide my rationale for doing so.
Emailing and Texting Clients
I sometimes email and on occasion text my clients but try to be conscientious whenever doing so. As I state on my website and reiterate when meeting a client for the first time, confidentiality can never be fully guaranteed on the Internet. I ask clients who choose to communicate with me electronically to do so sparingly and to limit such communications strictly to scheduling and confirming their appointments. I tell them to refrain from sharing personal or clinical information about themselves online. Should they need to reach me outside of our sessions, I encourage them to contact me by phone. Furthermore, from a legal and professional standpoint, I always remind clients that I archive all of our electronic communication, as such information is a part of their written record.
"Friending" Clients on Facebook
While I have embraced some forms of social media, there are others, such as Facebook and Twitter, that remain a mystery to me. I would advise any psychologist using Facebook or Twitter to be thoughtful about how doing so could potentially impact the therapeutic relationship. Therapists who interact with their clients using social media such as Facebook should think seriously about the ethical dilemmas that could arise from adding this dimension to the therapeutic relationship. As for Twitter, if you are receiving or sending tweets to a client, you should probably think long and hard of how doing so fits into the client's treatment goals. One San Francisco based psychologist, Kelly Kolmes, Psy.D., a Twitter regular with 20,000 followers, makes it her practice not to accept invitations to follow her clients on Twitter. Likewise, she discourages her clients from responding to her tweets. But even with such a policy in place, Kolmes acknowledges there is always the potential of having an exchange with a client without her knowing it. Given the anonymity of Twitter, I feel pretty confident I'm unlikely to adopt this particular form of social media into my practice anytime soon.
Despite the wonderful opportunities that social media provides psychologists, there are many ethical dilemmas that can arise. Each form of electronic communication has pluses and minuses and ultimately the risks associated with these digital forms of communication need to be carefully considered by each practitioner. As should be apparent from this post, psychologists are already integrating technology and social media into their practices, but are frequently doing so without much guidance or oversight. The APA has an opportunity, but also a responsibility to weigh in on this debate and provide much needed guidance in the form of ethical guidelines and standards. Without such leadership, psychologists such as myself will continue to struggle with the best ways to reach clients while remaining ethically grounded and professionally responsive to those we serve.
Tyger Latham, Psy.D. is a licensed clinical psychologist practicing in Washington, DC. He counsels individuals and couples and has a particular interest in sexual trauma, gender development, and LGBT concerns. His blog, Therapy Matters, explores the art and science of psychotherapy.