I have spent time lately training therapists and writing about a therapist’s boundaries online. And so now I am curious from the other perspective, what people think about connecting with their therapist online via social media sites like Facebook, MySpace or other similar social networks?
I guess it might help for those of you who are not in the counseling profession, to talk first about our code of ethics- what we as therapists, counselors, psychologists, social workers and psychotherapists must carry out to remain ethical. Regardless of the discipline, we all have a code of ethics that we are expected to follow, and with a few differences in intent and wording, there are some ethical tenents that remain universal. Two of these tenents are with regard to confidentiality and dual relationships.
While most ethical codes have not yet addressed social media in their codes, some of us in the field have interpreted the existing codes as applied to social networking as follows:
Friending a client on Facebook or MySpace could potentially breach confidentiality. While the client may agree or even initiate the connection, others who are friends of the therapist and/or the client may “connect the dots” and assume or confirm that the person is indeed a client of the therapist.
Friending a client on Facebook or MySpace could be interpreted as a dual relationship. As a therapist I do not socialize with my clients. I don’t meet my clients for coffee and I don’t go to their home for dinner. Inviting a client to my Facebook page is like inviting a client into my living room.
Feedback anyone? What do you think?
Have a beautiful summer day!
DeeAnna
on Jun 28th, 2009 at 7:52 am
Not a simple thing, is it? I’ve been in therapy off and on for 40+ years and remain in contact with a very few extra special ones. I’d be sad, but not devestated to no longer connect with them. However, I think they probably represent the rare cases where it works. Generally I wouldn’t recommend “friending” your therapist on social networks, but don’t believe anything should ever be 100% one way or another.
on Jun 28th, 2009 at 10:09 am
While I would be more than happy to “friend” my therapist, I have to agree that it really blurs the boundaries. Social Networking sites are just that: social. As you said, it is generally not acceptable for therapists to “hang out” with their patients, even if both parties think they would make good friends, it just really complicates the therapy.
That said, I think more private means of online communication are not just viable but useful, provided the therapist can maintain his/her boundaries with them. I also think that email, IM and texting could be powerful tools but also need clear and firm boundaries.
A therapist having access to a patient’s blog can be highly useful – you can go directly to talking about the content without having to read it in session. But there again are boundary issues because that’s requesting additional, uncompensated time from the therapist. But it must be worked out somehow in some cases because I know several people who have this arrangement. Sadly, I am not one of them.
on Jun 28th, 2009 at 12:38 pm
I am a therapist in private practice. I am clear that I would not friend someone on facebook, because I use that as a social context.
As you succinctly wrote you would not have coffee with a client and so on, neither would I. So why would I socialize with someone who is a client online? I use twitter to get my views out there so I would have to think about if that’s appropriate.
on Jun 29th, 2009 at 11:14 pm
Whilst I actually believe that if we had met in a different context, my therapist and I could have been friends, I do think it would be highly inappropriate for us engage in a social context whilst therapy is ongoing. If and when our sessions together draw to a close, perhas that would be a different matter, but until then the potential for disaster – both in terms of a client’s possible transference issues and the therapist’s private life – is too strong. Obviously that potential still exists once the therapeutic relationship ends, though I would hope a therapist would not discharge the client if this were likely!
Essentially, as others have said, Facebook etc are social, so I would agree that a relationship there, however vague, would be in violation of the general codes of ethics. However, I agree with Jenn that *some* forms of Internet contact such as email would be useful. In particular, I totally agree with the idea about a therapist reading the client’s blog could be very useful. The problem indeed is that of course the therapist can’t spend all his/her time on one client!
As far as I know my therapist doesn’t read my blog (and I have never shared the URL with him, so there’s no reason to suppose he might), but I will sometimes take excerpts in to him. I tend to articulate myself better there and the material serves as a clear basis for discussion.
But essentially I do feel that any online contact should be private and well within the boundaries of the therapeutic relationship, not social.
on Jun 30th, 2009 at 5:07 pm
Definitely a blurring of boundaries. More than a blurring even. As a client I have yearned to have my therapist as a “friend”, but I also know that’s inappropriate and will never happen. Part of me doesn’t even want it to. And the thought of have her on my Facebook list? Now that’s just creepy.
on Jul 2nd, 2009 at 8:53 pm
I am a therapist and have had a few clients attempt to friend me on Facebook. I think this would be OK if you only use Facebook as a tool for your business, ie. giving out useful mental health information. I have ignored the requests because my Facebook page includes family and friends interacting.
on Jul 5th, 2009 at 1:37 pm
This is happening to me as we post. I have just been sent a ‘confirm as a friend’ notification from two ex-clients. The two clients don’t know each other so I thought that Facebook had maybe got my email address from their address books and then automatically sent the notifications to me. This does happen. Although I don’t feel comfortable about it I have ignored both. I must hope they don’t interpret my silence as rejection. I agree that it would be unethical to socialise with clients, and even ex-clients. It could ‘potentially’ carry some risk for the counsellor, along with his or her family or friends, if a client forms an unhealthy attachment to them. I know of this happening -but not online. We share so much information with our contacts on Facebook without realising it. Having a client as a friend allows them a degree of intimacy that is counter-therapeutic.
on Jul 5th, 2009 at 3:10 pm
I definitely agree that it would be inappropiate to “friend” a client on any of the social networks. I also do not post anything on my facebook page that is too personal or revealing. I have explained to my family and friends that facebook is a “marketing” tool for me and some topics I just will not provide comments.
on Aug 5th, 2009 at 5:14 am
Clients attempting to ‘friend’ me on Facebook became such a routine dilemma that I now address it in my contract under Terms of Relationship. I point out that just as I would not attend their child’s birthday party or have drinks after session with them, I will not socialize in a ‘virtual setting’ as well. The relationship is professional and is maintained to protect their information.
Still, I can understand the intrigue of wanting to know more about this person who listens to my deepest, darkest secrets weekly without reciprocating. I remember a new client interrupted her own thought and in earnest commented, “Oh my goodness! I’ve been talking so much about me…now what about you?”
on Oct 19th, 2009 at 4:07 pm
While those of us who are practicing therapists can basically agree that this forms a dual relationship that should be avoided, I think it’s clinically useful, when a client sends a friend request or talks about the “friending” process, to talk about the matter openly in session. It’s not hard to find the right way to express to a client that Facebook friending shouldn’t really be part the therapist/client relationship, but the topic gets much more useful in therapy when exploring non-judgmentally what motivated the client to send the friend request in the first place. It’s a powerful occurrence in relational work.
on Dec 11th, 2009 at 6:49 pm
I noted on this site that there is a post from Jane Fortune. I want to make people aware there are two Jane Fortunes, and oddly enough, we are both therapists! Jane posted on this blog earlier (July 5), and she sounds great. She is the in the United Kingdom. I am in South Carolina, having recently moved from Virginia, in private practice. Just a note so that people, who know either one of us, will not get confused. A note about Jane, her spelling is slightly different (UK style), with double ll in counselling!!!
on Jan 11th, 2010 at 1:54 pm
DeeAnna,
I’ve read this blog post a few times, and found it helpful in framing questions I have for my human services organization. The ethics are clearer in a counseling/therapy relationship, as you point out, but your commenters indicate it may not be clear-cut, even in this field.
It’s far less clear in the areas of community support for people with intellectual disabilities, mentall illness, autism, etc. I’d be interested in hearing your thoughts about engaging in that related, but very different conversation.
on Jan 11th, 2010 at 2:22 pm
Hi Jeanine,
Thank you for your comments. Having worked with people with developmental disabilities for several years I completely understand your inquiry. The primary issue to consider is HIPAA- many people with developmental disabilities and mental illness are treated through insurance or medicaid/medicare funds. That being the case, the gray area becomes less gray. Clearly, if you are taking people on an outing and social adjustment/daily living skills/work skills are being modeled, then your interaction with that person is within the normalcy of the setting you are in. If you are in the role of “therapist” or “counselor” (insight oriented therapy is possible for some) then that means the service may be rendered in a therapeutic setting such as an office or center. Handling client confidentiality remains the same. And so that becomes part of the informed consent- consent presented in a way that the consumer and/or legal guardian can understand.
So for instance, I never acknowledge my clients in public. Some clients will acknowledge me and then I say a polite hello but I do not encourage dialogue if others are around. When I worked in settings that meant I would be in public with people teaching skills or escorting on a recreational outing, if someone inquired about who I was, or what my role was with the individual or group, I simply replied, “I am a friend.” I never revealed more than that.
So, when thinking about this same concept online, then the key becomes creating an online environment in which you can connect with your clients. That is fine, provided it is a closed and encrypted community. As other boundary issues online come up, the same informed consent process should take place. Laying out these boundaries as much as possible in the beginning is important. Explaining your role with clients in a way that they can understand is also important and something you can return to when needed to provide clarity.
I hope this helps!
DeeAnna
on Jan 11th, 2010 at 3:01 pm
It does, thanks. I’ll definitely make certain that informed consent (and regulatory imperatives) stay front and center in the conversations.
Jeanine
on Jan 29th, 2010 at 11:09 am
This is a very good topic for psychotherapists to pursue. I think encouraging the practice of clients “friending” their therapists is shortsighted. We all know, for example, that even in the best counseling/therapy relationship periods of negative projections and negative transference reactions are likely to occur — if the therapy has any depth. What happens when a client (at least momentarily) has a lapse in judgment and posts something negative on your FB page? While further therapy might otherwise salvage the working relationship, it might be difficult or impossible for a therapist to overcome their own frustrations and reactions to a client maligning them online. Therapeutic relationships are complex enough — Adding public interactions to the mix makes them far more complex and, IMO, unmanageable.
on May 4th, 2010 at 9:01 pm
I work at a homeless shelter as a casemanager. I am very careful about boundaries, even going as far as not friending coworkers as facebook friends. I found out today that two other casemanagers are facebook friends with current clients of theirs and this disturbs me greatly since I am a stickler on work is work and home is home. I have seen favoratism between the casemanagers and these clients for a long time and now to find out they are facebook friends I am wondering where professionalism has gone to. Where are the ethics? I really think friending clients is a big taboo.
on May 21st, 2010 at 12:06 pm
Recently, my client “friend ” requested me. We spoke about first why she did this and asked her why I wouldnt accept her request . Then I talked about code of ethics and history of therapists being tabula rasas. Then we spoke about boundaries, which led us into discussing her lack of boundaries within her family; the FB discussion served as a board to jump into the deeper issue. In short, the FB outreach was a transferential issue.