In our continually growing technological world, frequent use of the internet is increasing. The internet provides us with many conveniences and can offer us an array of goods and services rapidly. It can also connect us with communities and people. There are many benefits from going online, for example allowing us to stay in touch with distant friends and relatives, gather information and advice from like-minded people, or finding the right product or service that meets our needs. There are also problems that can be associated with the anonymity of communicating from behind a screen. Cyber bullying, unintended breaches of personal privacy, and rapid or widespread dissemination of information taken out of context can be a downside of having an online presence. To make sense of the current intersection of mental health and technology, I have introduced a social media policy into my practice.
The National Association of Social Workers, the Association of Social Work Boards, the Council on Social Work Education, and the Clinical Social Work Association have worked together in recent years to devise a standard that professionals in social work practice are expected to follow regarding the use of technology in our work, and the 2017 revision of the Social Worker Code of Ethics reflects this. My Social Media Policy and my Client Request for Electronic Data Transmission disclosure taken together have incorporated these expected standards into my mental health practice.
THERAPY AND THE INTERNET
Therapy is both a service and a relationship. Part of what makes a therapeutic relationship successful is that the nature of the relationship is both private, and one-sided. Traditionally I would advise clients that, should they accidentally run into me in public, it is my policy to ignore a client unless they were to approach me first, and I would avoid prolonged conversations and would not introduce a client or identify them as a client to anyone I was with. These measures serve to protect my client’s privacy.
Use of the internet has the potential to expand the ways in which clients and providers interact. Because both providers and clients may “encounter” one another online, it’s important for clients to understand the ways in which I intend to protect their privacy in the same way I would with an in-person encounter. As a psychotherapist, I have tried to be thoughtful in my own engagement online, and to limit my personal presence in public forums where a client may encounter me unexpectedly. However, as the use of the internet continues to become an everyday way of communicating, shopping, etc., I cannot always guarantee that a client will not encounter me online in an unexpected way. Should this occur and I am aware of their presence, I avoid direct interaction with them as I would in a public setting, and try to exit the interaction as quickly as it is feasible for me to do so.
If a client believes that they have encountered me online or they have a reaction to a post, article, blog, or comment that I made online, I encourage them to address these concerns directly with me. I also have suggestions on my written Social Media Policy of ways that clients can reach out to me anonymously with a concern, such as through my website “Contact Me” form (where a message could be sent under a pseudonym), or through a comment card left in my waiting room. There have also been times when I’ve worked with a client to devise a plan together to limit any unplanned “virtual” encounters in the future (such as by using the “block” feature on certain websites, such as Facebook.)
SOCIAL MEDIA AND MY CLIENTS PRIVACY
Maintaining professional and ethical boundaries with my clients in all forums is important to me. It is my policy to take steps to avoid encountering or interacting with my clients on the internet. This includes not “friending” clients in forums where this feature is available and “blocking” clients if I run across their profiles in social media forums. I may have personal opinions that I wish to share online, but I try to limit those and to be aware of my professional commitment to honesty, respectful communication and social justice. I have an ethical commitment to avoid unduly influencing my clients with my personal views, and I try to be mindful of the ways that my personal opinions that are posted online can be accessed. In addition, I do not interact with or comment on posts generated by my clients, and I do not “follow” or look up my client’s profiles or personal information online. I respect my client’s privacy and believe that the information they bring to me in sessions is the most rich source of data for our work together, and as such I do not seek collateral information about them online.
MAINTAINING VISIBILITY ONLINE
My private practice is listed online on various websites. I may also at times write articles or blog posts online on topics relevant to mental health, or be interviewed on these topics. Maintaining an online presence has become a common and necessary way for businesses including my mental health practice to connect potential new clients to my services. In some cases, listings are automatically added to these sites with or without the direct permission of the business owner. As a result, it is my policy to review and update these listings periodically to make sure that the information listed is accurate and current, rather than passively relying on these websites to list my practice without my input. Online info may at times be outdated however, so potential clients should be advised to verify information they find in past posts.
I review with my clients that encountering my practice online in a listing that includes a rating or review feature is not a request for a testimonial or endorsement from my clients. However, online forums can be a means of engaging in our right to free speech, and I welcome honest reviews of my practice should my clients want to do so. I am committed to their privacy and would not publicly respond to an online review or a comment, positive or negative, in a way that would offer any feedback or details about their care as a client. A commitment to privacy means not identifying a client publicly as a client of my practice, period, whether this is online or in the “real” world. I advise my clients however that sharing aspects of their own private information publicly, especially if they post something under their own name and not anonymously, may compromise their own privacy. Depending on the circumstances of the client (conservative work environments, child custody battles as examples), this could be of greater concern.
It is my hope that the overall stigma associated with taking the self-caring and responsible action of seeking help around emotional distress is lessening in our society, and admitting going to see a therapist need not be a secret. Nonetheless, clients need to be aware of social, employment or legal risks they may be taking if they choose to identify themselves as a current or past client of a mental health practice.
The bottom line is: the use of technology is growing, and the intersection of private mental health care and the internet will only likely grow over time. I strive to create a collaborative and productive relationship with all my clients, and a welcoming, comfortable and safe space. Technology is a useful tool, but it can be over-used. I encourage anyone with a comment or concern to reach out to me, and we can discuss it. I welcome feedback in all forms so that I can continue to improve service delivery to my clients.
NASW revised code of ethics (2017)
Social worker technology standards (2017)