Is it necessary to prevent therapists from using Facebook any more than it would be to tell them that they can’t go out to dinner for fear of running into a client? What, exactly, is the difference?
As a 30-something MSW student, I find that Facebook, LinkedIn, and Twitter have become some of my primary methods of communication with former and current colleagues, family, and friends.
I am, therefore, affected by this issue in a different way from people of previous generations who didn’t have such early exposure to the Internet or don’t communicate as much via social media. Likewise, my experience differs from that of the MSW student who will enroll in 10 years, having never known a past that wasn’t logged online.
The Internet gained popularity when I was in my early 20s. I joined Facebook in 2007 at the suggestion of my employer, to help promote the organization’s work.
Despite this later start, there is a lot about me online, as is true for many of us, because once the Internet evolved, it became standard practice to post various types of information, from professional bios to wedding announcements. A Google search will reveal that I served in the Peace Corps, teach improv, and do communications consulting. You could find that I’ve written an article about an Abba cover band. And, now, that I wrote this one.
These are not things I would likely share with a client in a therapy session.
And yet, most people my age or younger will be unable to escape such exposure to some degree by the time they enroll in an MSW program. Begging the question, is the “blank slate” therapist even possible in the Internet age?
Logging in to the Dilemma
In my first field placement, I didn’t have to consider any of this. I didn’t use my last name with clients because of the nature of the setting, and they were unlikely to have access to the Internet. However, in my current placement, I’m forging longer-term relationships with clients, all of whom have Internet access and are likely to use social media.
My question related to this issue centers primarily on dual relationships or harm to clients through therapist self-disclosure.
Although informal discussions of this have occurred among professionals (Scarton, 2010), little empirical research exists, but more is forthcoming, such as a recent study of online contact between therapists and clients (Kolmes, 2011).
The Ethical Web
In reviewing the NASW Code of Ethics, I found that some of the most relevant ethical dimensions of this discussion focus on the following issues.
Do no harm.
This principle asserts that when faced with dilemmas, social workers should endeavor always to choose the option that decreases or prevents harm (Dolgoff, Loewenberg, & Harrington, 2009). This value asks that we explore what level of harm exists for clients when therapists use social media and under what conditions they should be used or not used.
Although there is limited research on this, literature on self-disclosure and the alliance provides insight.
First, it is well established that the therapeutic relationship is one of the most complex and important aspects of psychotherapy (Glassgold, 2007). This is not an issue to be treated lightly.
Clients may prefer to think of their therapists as existing only in the therapy space. Potential harm may occur, then, when the client feels impinged upon by finding a therapist’s personal information online (Scarton, 2010). In one case, a patient experiencing erotic transference saw pictures online of his therapist in a bathing suit and was unable to continue treatment (Scarton, 2010).
Further, a situation may be created in which the therapist must decide whether to accept “friend” requests, potentially having to reject the client. Unlike running into a client at a restaurant, then, this forces a therapist to state who can access his or her social world (Scarton, 2010).
Blogs by therapy patients about this topic cite concerns about confidentiality, learning things they don’t want to know about the therapist, entangling boundaries, and having more difficulty letting go of the attachment after termination (TresSugar, 2010). Further, all eight commenters on one post agreed that they wouldn’t want an online relationship with their therapists (TresSugar, 2010). Commenters on a related post said it would feel “awkward” or “creepy” to find information about one’s therapist (imaginenamaste, 2009).
Alternatively, some theorists propose that the potential damage of finding therapists online would not be as great as many think, and it could even be beneficial, arguing that Twitter and Facebook allow therapists to share information about psychotherapy (Scarton, 2010). This could also help reduce stigma.
One writer argues that some approaches to boundaries—including via the Internet—are “overcautious or rigid in their interpretation and therapeutic limits” (Glassgold, 2007, p. 979). McWilliams cites research showing that some self-disclosure is inevitable and can enhance treatment, because “outcome is much more highly correlated with an attachment to a vivid individual person than with the application of any specific techniques” (2004, p. 182).
One could certainly argue that some information about the therapist could set in motion certain transferential aspects of therapy that may be beneficial to the client if worked through. However, the danger, as in the above example, is that the information may be so threatening that the client leaves treatment.
I also wonder, given how frequently social media is mentioned by clients, about the wisdom of therapists shutting themselves out of a very widespread and increasing part of our social fabric.
However, it remains unclear whether there are ways for therapists to engage online and minimize harm—and the extent to which they need to prioritize this to protect clients and the therapeutic alliance. Some methods might include high privacy settings, limitations to certain sites, not directly interacting with clients, or limiting content posted.
Unfortunately, there are currently few guidelines to help inform decision-making in this realm, as well as in terms of questions as to the responsibility of therapists given the possibility of even private sites being hacked and exposed, or information being visible unintentionally via networks.
As one physician stated, “It’s more important for us to be a bit more careful about who we friend and who we don’t friend” (Foreman, 2010). Related ethical questions ask us to extend this to also consider to what degree therapists are responsible for protecting their information.
Quality of life.
This value asks us to consider whether social media enhances the quality of life “for all people” (Dolgoff, 2009, p. 68). This would affect whether or not social workers would want to publicly model the behavior of using it. Unfortunately, there is no definitive knowledge that would indicate whether social media is a benefit or a bane for people, communities, or society as a whole.
Right to privacy and confidentiality.
By nature, online relationships are not private. As relationships under observation, they can inherently infringe upon client confidentiality, indicating that direct online relationships between therapists and clients are inappropriate.
However, this also encourages us to consider that, for therapists who do engage in online interactions with clients, it is critical to consider the importance of informed consent and related ethical practices.
It should also go without saying that therapists should never post client information online, even anonymously. The prevalence of those doing so is surprising, as therapist Susan Giurleo points out, while also arguing that this isn’t a sign that therapists need to give up social media, but that they need to be more judicious in its use (2010).
This value also points to the need for guidelines to be established to help social workers understand the ethical parameters of using social media.
The value of “full disclosure” states, “A social worker should make practice decisions that permit her to speak the truth and to fully disclose all relevant information to her client and to others” (Dolgoff, 2009, p. 68), asking us to look at the extent to which it is necessary or appropriate to forewarn clients about a therapists’ online presence since it could become relevant if the client comes across it—on purpose or accidentally.
Therefore, we may be wise to consider preparing policies or paperwork for clients that might disclose fully and make open to discussion how the therapist manages her online presence, the therapist’s boundaries related to social media, the nature of information available about the therapist online, and the implications of searching for such information to the therapeutic process. Some practitioners have such mechanisms in place (Scarton, 2010).
Why Am I All A-Twitter?: The Personal Perspective
This framework helps clarify a complex ethical topic that has not yet been widely discussed or researched; however, it does not address the personal considerations of social workers such as myself who use and value social media. This will be of increasing importance as the younger generations—who have hardly known an existence without social media—take their place in the profession.
We will need to grapple with this reality and with the differing attitudes about social media between the generations, particularly because social media is becoming more than an optional, “fun” outlet. It is rapidly becoming an integrated, primary means of conducting our social, civic, and professional lives.
As one writer explained, “Some therapists think total abstinence of social media is necessary. Younger therapists tend to disagree, since the Internet is so integral to their lives” (Scarton, 2010). One ethicist expressed concern that younger therapists understand the Internet very well, but may not understand the ethical and boundary issues that surround it (Scarton, 2010).
But it also behooves us to consider the reality that the online existence of those younger therapists pre-existed their decision to become therapists. And that their online existence is also how they participate in their communities, give to philanthropic causes, connect with friends, and advocate for policy change.
I, for one, can’t imagine giving up social media. It is integral to my life.
It is how I send, receive, and accept social invitations; participate in civic action, including policy advocacy; get my local, national, and international news; forge ties with out-of-state family and friends that I may not otherwise communicate with as regularly; exercise my sense of humor and creativity; share and receive information relevant to my life and interests; and keep up with professional trends and contacts.
For this reason, it is my belief that as a social work student and aspiring therapist, it is my duty to find a way to interact with social media in a way that is respectful and mindful of my clients and my profession as a whole.
As a result, I locked down my Twitter account and hid my Facebook profile in search. I find myself doing more self-censoring of information I post, not because it would violate confidentiality or be overtly inappropriate, but because I am now more mindful that the joke I was making may be misconstrued or cause misunderstandings that might reflect poorly on the social work profession. I deleted my personal blog.
However, these actions were not without personal loss.
I am a creative person. I greatly valued the ability to share my writing and thinking with others and to be part of the broader conversation the Internet allows. I sorely miss being able to do so.
Further, locking down my Twitter account and Facebook profiles limited my ability to interact with others. New contacts were not able to find me, and fewer people could see and interact with my Tweets. Over time, I found this frustrating. After a few more months of careful consideration, I dropped my Facebook security one level (I can now be seen in search), a decision I continue to struggle with.
I also recently opted to close my Twitter account and open another under an anonymous moniker. However, I do identify myself as an MSW student, to foster networking with other social workers and social work students Tweeting about issues of common interest. I decided that the value for me in being able to network and share ideas, as well as the sense of fun and play I find through such interactions, weighed heavily enough for me to take this risk. I am also mindful each time I post that, although unlikely, it could be traced back to me if someone were extremely committed to doing so.
This process has been, for me, very much an exploration of my own boundaries, as well as my therapeutic ones. It has raised the question for me not only of the ethical parameters of social media use in regard to how we work with and have an impact on our clients, but also their relevance to our own lives.
Given the saturation of social media in our lives, it may be necessary to ask every MSW student to engage in some sort of education around social media and its implications for their new professional role. This might occur as part of the ethics course or even clinical practice courses. This would allow new social workers to explore such issues and their implications in depth and to understand the risks and benefits associated with their use of social media. It would also give them the information necessary to make informed decisions that resonate with their personal and professional values. Just as we write papers to process our feelings about race and gender, it may soon be necessary to ask students to process their feelings about their use of social media.
I know that doing so for me has been a crucial step in my professional development.
In our studies of ethics, we are taught that, “Codes of Ethics generally provide guidance only for good/bad decisions. They are far less effective in helping practitioners make decisions of the good/good and bad/bad variety” (Dolgoff, 2009, p. 37).
It is becoming increasingly clear that use of social media by social workers is rapidly evolving into the latter variety, given that action on either side has consequences for clients and therapists alike, and for their relationships inside and outside the therapy session.
We do not yet have enough information about these potential consequences. Unfortunately, the drumbeat of Tweets isn’t slowing down to wait for us to figure it out.
It is understood and within our Code of Ethics that we, as social workers, are to put client interests above our own. However, it is also understood that we are to practice self-care and value human relationships (National Association of Social Workers, 2008).
As a profession, we are likely going to need to include these considerations—as they apply to the lives and well-being of our own practitioners—in discussions about the ethical use of social media by those practitioners.
Undoubtedly, our hitting “post” could potentially harm our relationships with our clients, but being unable to also imposes increasingly real costs to those who must refrain.
Not being on Facebook doesn’t just mean not being able to play Farmville anymore. It potentially means missing a valuable opportunity to connect.
Dolgoff, R., Loewenberg, F., & Harrington, D. (2009). Ethical decisions for social work practice. (8th Ed.). Belmont, CA: Brooks/Cole CENGAGE Learning.
Foreman, J. (2010, April 26). You, your doctor and the Internet. Los Angeles Times.
Retrieved March 9, 2011, from http://articles.latimes.com/2010/apr/26/health/la-he-facebook-20100426.
Giurleo, S. (2010, July 16). Twitter, confidentiality and our small world: A story for therapists. In drsusangiurleo.com. Retrieved March 9, 2011, from http://drsusangiurleo.com/twitter-confidentiality-and-our-small-world-a-story-for-therapists/.
Glassgold, J. (2007). Redrawing the boundaries of psychotherapy: Is it ethically possible? PsychCRITIQUES, 52 (28), 978-979.
imaginenamaste. (2009, May 18). Now you can Facebook-stalk your therapist. In Grey Thinking. Retrieved September 11, 2010, from http://www.greythinking.com/2009/05/18/now-you-can-facebook-stalk-your-therapist/.
Kolmes, K. (2011). Research. In drkkolmes.com. Retrieved March 9, 2011, from http://drkkolmes.com/research/#therapist%20survey.
McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner's guide. New York: Guilford Press.
National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved March 9, 2011, from http://www.naswdc.org/pubs/code/code.asp.
Scarton, D. (2010, March). Google and Facebook raise new issues for therapists and their clients. Washington Post. Retrieved September 6, 2010, from http://www.washingtonpost.com/wp-dyn/content/article/2010/03/29/AR2010032902942.html
TresSugar. (2010, April 27). The pros and cons of “friending” your shrink. Retrieved September 11, 2010, from http://www.tressugar.com/Being-Facebook-Friends-Your-Therapist-Pros-Cons-8252952.s.
Lisa Kays graduated in May 2011 with a clinical MSW from The Catholic University of America and wrote this article as part of her ethics coursework. Lisa also has an MA in journalism from American University, and her previous career was in communications and marketing for nonprofits.