3 Ethical Fears of Being a Therapist Online and How to Resolve Them

Every therapist knows that ethics is a critical component of working with clients. Once you add social media into the mix, things can get even more complicated. I’ve noticed that unfortunately, some in the profession are resistant to embracing technology and building an online presence related to their practice because of fear of the potential ethical problems. It’s true that there are risks involved in going online, but we don’t need to be run by this fear; the risks can be managed, and, as we’ve talked about so many times before, the benefits are staggering.

Here are 3 Ethical Fears of Being a Therapist Online, and How to Resolve Them:

1) A Client Breaking Professional Boundaries

If you’re findable on the internet, naturally you’re easier to contact as well. And while we find that most clients respect boundaries with their therapist, some may choose to disregard common rules of protocol, especially when a professional’s online presence facilitates their ability to do so.

Mari A. Lee, an LMFT who specializes in sex addiction recovery, prevents this by having her clients sign a social media form as part of the intake packet. “I do not allow clients to post to my business Facebook page or private message me,” she explains. “I do not accept friend requests or professional links from therapy clients on LinkedIn.” Mari describes how the few times that a client has attempted to add her, she simply redirects them back to her policy. By doing, she has never encountered an incident of professional boundaries being crossed (read more about Mari’s experience here).

Overall, being clear about what is and is not acceptable for your clients with regards to social media will all but prevent problems from occurring. Develop a social media policy for your practice, include it in your initial client paperwork, and have it available on your website (read more about developing a social media policy here). While you must be firm about your boundaries, try to communicate your expectations in a way that is not alienating or harsh. A client reading your content online is a good thing, so you don’t necessarily need to discourage all forms of social media engagement; it is direct contact that is prohibited.

2) The Risky Possibility of Dual Relationships

We all know that therapists in private practice should be cautious when entering dual relationships with clients and be mindful of  the potential risk of exploitation or harm to the client. This caution extends to online dual relationships as well. If you as a therapist have an online presence and engage in multiple professional activities (publishing, consulting, etc.), you might be worried that a client could feel pressured to purchase additional services or products from you. Whereas before you were a person that your client saw in an isolated setting, you are now an established figure that he/she can read about or follow anytime on the internet.

This fear really is unfounded. It’s okay for someone to find you online and understand that you are selling something in addition to seeing clients. As long as you’re not soliciting these things during a private session, you don’t need to try and hide the fact that you do other things. Your ethics courses taught you what need to know about avoiding these kinds of interactions.

If you think there might be a legitimate possibility that your outside professional activities encroach on the ethical integrity of your counseling, consider the following: Dr. William Doverspike, a licensed psychologist and president of the Georgia Psychological Association, proposes a very simple ethics test when contemplating dual relationships. Ask yourself these 5 questions to determine whether or not your online activities are ethically sound in relation to your clinical practice:

Is there a chance of:

1. loss of effectiveness of the professional?
2. loss of objectivity of the professional?
3. loss of competence of the professional?
4. risk of exploitation of the client?
5. risk of harm of the client?

If you can answer an honest no to all of these questions, you’re just fine in pursuing your other activities.

3) Posting TMI

Most of us have witnessed someone who gets too personal on Facebook or on other social media outlets. These platforms can be great for sharing information and photos and keeping in touch with one another, but sometimes people go too far.

Being cautious with social media activities becomes even more important for a therapist with an online presence. Where does your personal life begin and your work life end? Would your relationship with your client be jeopardized by something you posted about your own life? Is it possible for something to be appropriate for your personal page but not for your business page? Keep in mind that social media platform privacy settings are constantly shifting and that there is no guarantee that some information posted on personal profiles may still be accessible.

I trust that my friends reading this right now aren’t the type who post blatantly inappropriate or disrespectful material, but it can still be challenging to find that line. Here is the rule that I’ve created for myself that has worked well for me: if I wouldn’t feel comfortable with anyone in the world viewing it, I won’t post it at all. It’s that simple.

Once again, this potential ethical problem is easy to avert. Use common sense, your ethics training, a social media policy, and your best judgment. Overall, just trust yourself as to what to post; you are a professional after all!

The point of this post is that you don’t need to be run by fear when it comes to social media engagement. I encourage you to embrace the technological world and let it benefit both you and your clients.

I wrote an in-depth article about social media ethics. Click here to read it.

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Pause Before Posting About Work On Social Media Pages (part 2)

Guest post by Kimberly Sandstrom, MFTI

We all have days where we need to let out a little steam about a difficult day at work. Social media is not the place to do it.

In the first post on this topic, my goal was to bring awareness to our community about the hazards of posting personally about clients. Although our clients may not see our personal posts (see Julie Hanks Digital Dual Relationship Dilemmas), our own personal communities will, and our reputation is built on that community.

While my personal profiles are private, my extended friendship community and family I am connected with on these sites, trust me and my ability to keep things confidential for their referrals What I portray on my personal and professional sites will reflect the reputation I have as a therapist.

Does this mean we cannot post anything at all about the work we do on our personal accounts? Certainly not! My heart is for fostering a safe environment for consumers so they will feel comfortable sharing with us in the intimate space of our offices, and assurance that their stories will be kept contained within the walls of our office. Here are some tips to protecting not only yourself but our therapeutic community at large when posting about your therapeutic work.

Think before you post

Ask yourself these questions: If my client saw this, would they like what I posted about them? Is this fostering a positive message about my therapeutic community? What are my motives for posting this (i.e., vent frustration, draw others to me through humor, etc.)? Am I venting my frustration in a way that protects my client and my reputation? Would it be better if I shared this with another colleague privately?

Keep your posts about work general and positive

After a recent couples intensive weekend, my co-facilitator and I were so blessed to see the positive transformation in the couples that attended our workshop. It inspired us. I posted on my personal Facebook profile, “So blessed to watch couples transform their relationships over this weekend at the couples retreat. I love my job!”  Nothing specific about what conversations took place. If one of the participants to read this, it would most likely reflect their own positive experience of the weekend. Occasionally, I have asked for permission from clients to share their inspiring story or something they have written (poem, inspiring reflection) in a blog or to post on my professional social media sites, and again, I keep the information general and positive. And I make sure it is in a place they can see this posted (even though I do not accept former or current clients on these sites—they are open to the public to view).

Develop safe relationships with like-minded colleagues in your own community

We all have funny and frustrating stories from work—no matter what profession we are in. Developing relationships with other therapists in your community can provide you with a group that follows the same values of confidentiality that you do. You can vent your day to them, share funny stories (without giving identifying information about your clients, of course!), and explore your own triggers and countertransference in confidence, instead of publicly.

Have grace with fellow clinicians who may violate this gray area

If you feel inclined, send them a private message with your concerns about their post. If it is done with a spirit of helpfulness, gentleness, and affirms their good intention, they will most likely be grateful.  If, after reading this, you realize that you may have posted something about a client that qualifies as negative or comical, have mercy on yourself! We are human, fallible and worthy of lots of grace in the uncharted territory of social media etiquette!

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.

social media image (c) CanStockPhoto

Social Media Ethics (part 1): Digital Dual Relationship Dilemmas

photo credit: Eric Schwartzman

I’ve spent months writing about how to effectively use technology, and social media in particular, to build your private mental health practice. While the Internet has opened up exciting new ways for mental health therapists in private practice to market their practice, reach potential clients, and educate the public, it has also allowed for new ethical dilemmas.

When I first started practicing nearly two decades ago, I was concerned about my child being on the same soccer team as a client's child, or about running into clients at parties of mutual friends. The increasing Internet usage by therapists and clients alike has created new opportunities for dual relationships online. Over the coming weeks I'll be discussing ways to use social media ethically in the digital age.

Here are a just few examples of digital dual relationship dilemmas that therapists now face:

• “A former clients sent a ‘friend’ request on my personal Facebook page? Should I accept it?”
• “One of my clients is a friend of one of my family members on Facebook. I don’t want him to have access to my personal information, photos, etc. Is there anything I can do to protect my personal information?”
• “A client just posted a comment on my private practice Facebook page that reveals some clinical information about his symptoms. How should I handle this?”
• “A potential client sent me a direct message on Twitter inquiring about my therapy services. Is Twitter confidential? How should I respond?”
• “During an initial intake with a new client the client shared some grandiose facts about her successful work history and public accolades. Should I Google her name to see if what she’s reporting is true?”
• “I just saw that a client is following me on Pinterest. I’m not sure how I feel about her seeing boards about how I want to decorate my dream house.”
• “Should I enable or disable comments on my private practice website blog? I'm concerned that it may look like I'm encouraging clients to comment on my blog."

I want to hear from you...

Have you faced any of these situations in your clinical practice?

What are some ethical dilemmas you've come across since venturing into social media?

Do you have any specific questions or ethical concerns about the impact of your online activity and it's potential impact on the client-therapist relationship?