Con­sider these sce­nar­ios (adapted from Dr. Jeff Ashby’s May 2012 APA pre­sen­ta­tion “Pro­fes­sional Issues In The Infor­ma­tion Age”):

You have had a per­sonal Face­book page for some time that you do not mon­i­tor closely. You have typ­i­cally posted pic­tures of fam­ily gath­er­ings and occa­sional “likes” and “com­ments” on oth­ers’ pages. Because you do not mon­i­tor the page closely, you have always responded to friend requests by sim­ply accept­ing them. In check­ing your Face­book page for the first time in a week or two, you notice that a cur­rent client has posted on your wall. You quickly inves­ti­gate and real­ize that some months ago you accepted a friend request from this per­son along with sev­eral other peo­ple you either didn’t rec­og­nize – or only vaguely recalled.

A per­son who found you on LinkedIn indi­cates they also looked up your Face­book page and says that “you seem like the kind of per­son who could really help me” and wants to sched­ule an appoint­ment for ther­apy services.

Six months after the suc­cess­ful com­ple­tion of a two year coun­selling rela­tion­ship, a ther­a­pist agrees to “friend” his for­mer client on Face­book as a way of pro­vid­ing min­i­mal sup­port and encour­age­ment. The coun­sel­lor and past client engaged in lim­ited mes­sag­ing the ther­a­pist clearly saw as “benign” in con­tent. When the ther­a­pist went away on vaca­tion to a place with lim­ited inter­net access, the ther­a­pist was unable to read and respond to his for­mer client’s increas­ingly fre­quent, plain­tive, and even­tu­ally des­per­ate Face­book posts. The ther­a­pist returned from vaca­tion and, on check­ing his Face­book page, found a mes­sage from the client threat­en­ing sui­cide approx­i­mately 3 days old… and no other messages.

A client notes that she has recently read your blog posts. She indi­cates that in read­ing a recent post, she was struck by your dis­clos­ing con­fi­den­tial infor­ma­tion about her case. You recall the post and, specif­i­cally, that you spoke gen­er­ally in the blog and was not ref­er­enc­ing any client. You attempt to com­mu­ni­cate this to the client but she is increas­ingly dis­tressed by your unwill­ing­ness to acknowl­edge that you have bro­ken confidentiality.

What are the pri­mary issues for you to con­sider in these cases? How should you proceed?

All com­mu­ni­ca­tion is sub­ject to good eth­i­cal practices

In today’s age of e-mail, Face­book, Twit­ter and other social media, psy­chol­o­gists have to be more aware than ever of the eth­i­cal pit­falls they can fall into by using these types of com­mu­ni­ca­tion. Nei­ther the Cana­dian or Amer­i­can Psy­cho­log­i­cal Asso­ci­a­tions have ethics codes that specif­i­cally address social media, but the codes are clear that they apply to all  psy­chol­o­gists’ pro­fes­sional activ­i­ties and to elec­tronic com­mu­ni­ca­tion, which of course social media is.

Con­sider this:

• if you are com­mu­ni­cat­ing with your client via e-mail or text mes­sag­ing, are these com­mu­ni­ca­tions part of your client’s record? Who has access to these com­mu­ni­ca­tions (e.g. the inter­net ser­vice provider)?
• is it appro­pri­ate to use social media to learn more about a client (e.g. search­ing the client’s Face­book pro­file or Twit­ter)? Is the client’s con­sent required?
• is it appro­pri­ate to post per­sonal infor­ma­tion about your­self on a blog or web­site when that infor­ma­tion can be accessed by a cur­rent, or poten­tial, client?
• do dif­fer­ent con­sid­er­a­tions need to be made if you are pro­vid­ing treat­ment for an indi­vid­ual, and e-mailing or tex­ting them on one or two occa­sions, ver­sus pro­vid­ing treat­ment solely through elec­tronic means (and never hav­ing met face-to-face)?

“We are just begin­ning to under­stand what eth­i­cal issues the Inter­net is rais­ing,” says Stephen Behnke, ethics direc­tor for the Amer­i­can Psy­cho­log­i­cal Asso­ci­a­tion. “To write rules that allow our field to grow and develop and yet pre­vent [patient] harm at the same time: That’s the challenge.”

Issues that may cre­ate eth­i­cal challenges

1. e-mailing and tex­ting clients (what staff mem­bers read and respond to emails? what are the bound­aries of appro­pri­ate mes­sage con­tent? when is it not appro­pri­ate to com­mu­ni­cate via email or text? are copies of cor­re­spon­dence a part of the client record?)
2. shar­ing per­sonal infor­ma­tion online (what social pres­ence do you have: Face­book, LinkedIn, online vitae, arti­cles you’ve writ­ten online, blog­ging, YouTube videos?)
3. “friend­ing” (Face­book) or “fol­low­ing” (Twitter)
4. tweet­ing and blogging
5. con­sumer review sites

Inter­est­ingly, clients are search­ing for infor­ma­tion about therapists:

A sur­vey of 332 clients (Kolmes and Taube, 2011) revealed that 70% found per­sonal infor­ma­tion about their ther­a­pist on the internet.

Some tips for your social pres­ence online

• learn about, and apply, the pri­vacy set­tings on your social media sites
• search for infor­ma­tion about your­self online and cor­rect any misinformation
• always con­sider the poten­tial impact of your online actions
• be cog­nizant of the dis­tinc­tion between per­sonal and pro­fes­sional use of social net­work­ing sites
• main­tain clear bound­aries with clients regard­ing poten­tial blended roles
• be thought­ful about who you accept on your friends list, thereby grant­ing access to your per­sonal infor­ma­tion (Facebook)
• be mind­ful that what­ever you share online will be avail­able to any­one and can­not be taken back
• never access a client’s per­sonal infor­ma­tion online with­out their permission
• uti­lize the pro­fes­sional ethics codes and con­sul­ta­tion with col­leagues and pro­fes­sional bod­ies for ques­tions of eth­i­cal decision-making
• cre­ate a pol­icy for social net­work­ing and make this pol­icy avail­able to clients as part of the informed con­sent process

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