I came across an article that did an amazing job of neatly summarizing the challenges of being a clinician in a wired world. Clients are increasingly involved with social networks. They will Google their therapists and their therapists will be tempted to do the same. And that's just for starters.
Written from a psychologist's point of view, I encourage everyone to read "Best Practices for an Online World."
In the meantime, these are key points covered in that article:
Most people don't think twice about disclosing their personal information online.
The contrast between psychotherapy and social networking sites could not be starker. Most psychotherapeutic interactions are private and confidentially protected, while most interactions on social media are broadcast to the public or to a network of friends. But when therapists interact in both spheres, they do risk violating clients' confidentiality or crossing boundaries.
There is evidence that younger professionals may already be navigating these ethical waters with limited guidance. A study found that 60% of medical schools sampled reported instances of medical students posting unprofessional online content, which included disclosure of patient confidentiality, profanity, discriminatory language, depiction of intoxication and sexually suggestive material. Another study found that 98% of doctoral psychology students had searched for at least one client's information over the past year.
Social networking sites may be ushering in a "small world" online environment that is analogous to "small world" rural settings where psychotherapists have encountered more transparency than their urban counterparts for years. Small world ethical thinking refers to a therapist's heightened awareness that his or her environment will likely produce ethical dilemmas surrounding boundary violations related to online realities such as greater transparency, increased self-disclosure and unavoidable multiple relationships.
Overall, it is important for clinicians to recognize that their "private" online activity may intersect with their professional competence. Indeed, online self-disclosures may represent the intersection where dilemmas surrounding personal and professional roles meet - in some cases signaling the start of boundary violations.
Self-disclosure online is almost inevitable. Often it is initiated by clients who want to learn more about their therapists. Some clients may do more than a Google search: They may join social networking sites, join professional listservs/chat rooms, or pay for online background checks or online firms to conduct illegal, invasive searches.
Practitioners need to create and maintain a formal social networking site policy as part of the informed consent process. Informed consent processes should at the very least acknowledge the risks and benefits of using social media and other technology. In addition, such policies should lay out psychologists' expectations for using such sites, namely that practitioners do not "friend" or interact with clients on social networking sites.
Therapists should develop online technological competence - they must understand the nature and requisite technology of social networking sites. They should proactively set controls that limit who sees their personal information.
Clinicians should contact both their professional and personal liability insurance representatives to find out whether their professional and personal liability insurance covers social networking sites. Psychotherapists should avoid using certain types of speech online, even if they use high privacy restrictions and other protections, such as pseudonyms. These communications might include breaches of client or supervisee confidentiality, speech that is potentially libelous and speech that denigrates the reputation of the field in which they practice.
We work in interesting times...
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