Pause Before Posting About Work On Personal Social Media Pages (part 1)

We all need to vent about a hard day at work, but clinicians should think twice before posting on personal social network pages.

Guest post by Kimberly Sandstrom, MFTI

Have you ever have a long day at the office and wanted to vent your frustration to someone? Me too! We are containers of all sorts of confidential information and sometimes our containers get full, or we get triggered by something that happened during the day. It’s hard to hold it all in at times—especially when it touches or triggers some reaction in us. Yet, we are called to an oath of confidentiality, and sensitivity to our client’s information. For most, venting to a trusted colleague or a relaxation activity can be enough. Yet, some therapists use their personal social media accounts to release stress about their clients. Can’t believe clinicians do this? Read on.

As therapists, we reach in, listen, validate our client’s pain and help them make sense of it so that they can reflect, respond, and repair the distance in their relationships. It can be emotionally draining work. And we need ways to work out our stress. But are personal social media accounts the place to do this? Probably not.

Yet, some therapists post things their clients did or said that made them laugh or made them upset.  Yes, you read that right. I’ve seen complaints about cancellations, clients not following treatment plans, and negligent parents. Then there are the posts intended to be funny—pictures of notes clients left for them (yes, I have seen this), pictures of children in the local paper they treat (this too!). Friends comment back “lol” or similar funny retorts, and then everyone gets a good laugh.

My heart drops whenever I read these posts.

What about all the people in their friendship circle who are in therapy or contemplating therapy? Do they wonder if their own therapist is posting something they said? I know I would.

We have such a wonderful opportunity to promote a positive image o

f ourselves and our therapeutic community and to cultivate confidence in the therapy process (see Julie Hanks' article on using social media in practice). We also have an opportunity to foster community with our public who often need courage just to pick up the phone and call us for support. Posting about clients negatively undermines these opportunities!

The good news is that therapists who post in a negative or comical fashion about their clients are definitely in the minority. And, given that I have seen some of these posts myself online from people I know, I take the view that their posts are not meant to be harmful but meant to release steam from a difficult day, or to draw others in as a way to cope with the “compassion fatigue” often experienced in this line of work. While the person posting does not intend harm, ultimately, in a round-about-way, they can elicit harm. How do we address this problem as we experience stress burnout and how do we address this with our therapeutic community?

Next time, I will provide tips on how to create self-awareness of our personal postings about our work, promote a positive image of therapy, and how to approach colleagues who may not be aware of how their posts about clients impact our wonderful therapeutic community.

Kimberly Sandstrom is a Marriage & Family Therapist Intern and Relationship Educator, Supervised by Kathryn de Bruin, LMFT, working in private practice in San Diego, CA. Married for 24 years, she and her husband are raising three daughters, two of whom are now adults.  She works with couples, and families to create emotionally safe and enduring connections in their most cherished relationships.

How To Get Paid For No Shows

photo credit: Marcin Wichary

Are you going to work and not getting paid?

Therapists in my consulting practice frequently complain of a high no-show rate, especially with new clients. They often feel powerless to enforce their policies fearing if they're too strict, clients will drop out of treatment.

I used to have this problem, too, and ended up feeling resentful when I had rushed to get to my scheduled session only to have a client no-show. There were also those days when a handful of clients who didn't show up or cancelled at the last minute. Since I was paying for child care there were times when I actually lost money by going to work. I knew something had to change.

While some clients would pay for the no-show or late cancellations at their next appointment, others would drop out of therapy, not return phone calls, and not respond to bills I sent to them. Additionally, many of the managed care panels I participated on at the time didn't reimburse for no-shows, and our contract didn't allow me to charge the client for sessions not attended. This was another reason I resigned from all managed care panels.

May I have your credit card number?

A few years ago, I started requiring new clients to provide a credit card number before they could schedule an initial appointment with me or any of the therapists at my clinic. New clients were informed that they would not be charged until the time of service, but that our policy is to charge the therapist's full-fee for no shows and cancellations made within 24 hours of the schedule appointment time.

If hotels, massage therapists, and hair salons can require a credit card to hold your room or appointment, why can't therapists require clients to make a financial investment in their treatment the actual sessions? Surprisingly, we've had no resistance from new clients when my office manager tells them about our policy and ask for their credit card number. Not surprisingly, my practice has very few no shows or late cancellations and the few that we do have, we charge for.

For my clinic of 13 therapists our percentage of no-show or late cancellation sessions that we don't collect our full-fee is less than 1% of our total number of sessions.

Suggested script for taking credit card number

I have an amazing office manager who screens all new client inquiries, informs them of how to access new client paperwork, takes down the credit card number and explains our financial policies Here's an example of what she says.

Yes, Julie has an opening next Wed. at 3:00PM. In order to confirm that appointment with Julie we require a credit card number on hold. You will not be charged until the time of service and you're free to use another form of payment at your session. What type of card would you like to use?

If for any reason you are unable to make your scheduled appointment time please give us at least 24 hours notice of cancellation or we will charge your credit card for the full session amount. Do you have any questions?

Tightening up our no-show policy has:

1. Weeded out the clients who aren't ready to commit fully to the therapeutic process.
2. Motivated our clients to be in charge of their appointment times and give us ample notice if they can't attend a scheduled session.
3. Allowed my therapists to get paid for sessions whether the client shows up or not.
4. Saved administrative costs and collection fees.
5. Trained clients to value and respect our time and services.

Is it time to tighten-up, modify, or enforce your no-show or late cancellation policies?

What challenges do you face in enforcing your policies?