By now, most practitioners who use social media websites know that if they receive a friend or connection request from a current or former client, they should decline it. If pressed, they should explain that doing so helps protect their privacy and establish therapeutic boundaries.
But lately, many clinicians are encountering a new challenge: what to do when clients show up in each other's "People You May Know" sections.
Experts say such recommendations likely happen because the clients all had the therapist's phone number in their contact list, or because the location-tracking setting on their smartphones put them in the same office every week—or both.
"The same kind of recommended connections are happening on social media between students and teachers and lawyers and judges—it's not just among psychologists," says San Francisco–based clinical psychologist Keely Kolmes, PhD. "But we are one of those specialized groups where it gets incredibly complicated because of confidentiality concerns."
Of course, social media's invasion into what many may consider private information is another part of modern life psychologists need to adjust to. Practitioners can protect themselves and their clients from confidentiality and multiple relationship breeches by:
Getting to know the social media technology. The goal of sites like Facebook and LinkedIn is to increase their user numbers, so it's important to know that when LinkedIn asks if you want to expand your network, the site will use your electronic address book to email everyone in it—including your patients if you've contacted them via email. Be sure to carefully examine the list of individuals the site wants to reach out to, ensuring no current or former clients are on it. If you're using social media for personal reasons—to stay in touch with friends and family, for example, create an alternate or private profile that only friends and family know, suggests John Gavazzi, PsyD, a clinical and consulting psychologist in Harrisburg, Pennsylvania.
Clinical psychologist David Palmiter, PhD, a psychology professor at Marywood University and private practitioner in Clarks Summit, Pennsylvania, says he works from the premise that "no one is going to be nearly as concerned about my privacy or my patient's privacy as I." One way he protects privacy is by using only secure WiFi networks or, if needed, using an IP anonymizer so that websites cannot identify his location or easily track information about how he's using the internet. He encourages some clients to do the same. He also encrypts sensitive attachments using Adobe Acrobat Pro before sending them, and avoids emailing anything he wouldn't want others to read. He also suggests using an email encryption program such as Sharefile, which offers security features such as two-factor authentication and single sign-on.
Talking to clients about their privacy concerns. Kolmes advises all clinicians to discuss privacy risks involved in using social media with their clients and to work through how to handle a situation in which a therapist's name pops up under their "People You May Know" tab.
"It's about having clear and open conversations with your clients about what you're going to do to protect their privacy and confidentiality and avoid inviting a multiple relationship, and letting them know they can also discuss this with the therapist if it comes up on their end," Kolmes says. When she does receive a friend request from a client on Facebook, she waits until she sees him or her next in session and checks to see if the request was accidental or not. Regardless of whether they searched for her or just had her recommended as a friend, she reminds them about the importance of patient confidentiality and privacy, and notes that following one another on social media can add a "social" element to their work and can complicate matters when it comes to what the therapist is supposed to know or not know about them.
She also cautions her family about the possibility of receiving a social media connection request from one of her clients.
"I have said to my family members, 'If you get a Facebook friend request from someone you don't recognize, be careful, as it could be someone who works with me and who is curious about my family,'" she says.
Developing a social media policy. Many psychologists have also developed social media policies that they provide to new clients as part of their informed consent process. The policies explain that they do not engage with clients on social media in an effort to maintain the therapeutic relationship and protect patient privacy and confidentiality. To further protect clients and their whereabouts from ending up on social media, Palmiter recommends that patients turn off their cellphone's location tracking feature, put it in airplane mode to turn off WiFi or even leave their phone in the car when they come to his office.
Being careful not to create stigma. In light of these privacy woes, however, it's also important to avoid expressing too much concern about others finding out a patient is in therapy, Palmiter says. "My only hesitation about some of these communications is that it could implicitly support this idea that being in therapy is something to be embarrassed about," he says. "If I was a dentist and I told people they might want to put their cellphones on airplane mode so that their location couldn't be tracked, most of my clients would say, 'I don't care if people know I'm at the dentist.' I can't imagine that any of my therapy clients would have that same reaction about my caution."
