Whether we were trained in this century or one of the centuries past, we therapists find ourselves – for better or for worse –practicing in a digital world. In an article on social media and health care, one medical professional quipped “Take two aspirin and tweet me in the morning.” This is not entirely facetious, in that Social Networking Services (SNS) have become a reality of mainstream life – both personal and professional. Originally conceived as online social communication networks for connecting people who shared certain common interests, social networks like Facebook and Twitter have rapidly exploded into vibrant parallel universes.
Facebook, for example, which was created in 2004, announced in March 2013 that it had 1.11 billion active users. That statistic will – of course – be wildly outdated by the time you read this article. As a point of reference, the world population in early 2014 is estimated to be 7.2 billion. If both of these numbers are accurate, at least one in every seven human beings on earth is an active Facebook user. In light of such statistics, the inevitable is, of course, happening. The world of professional communication is being rapidly swept into the “new normal” medium of social networking. And therein lies the problem.
As is the case with most innovations, there are benefits and there are risks in the use of social networking. The benefits are usually seductive, promising increased speed, efficiency, and convenience. The risks are usually hidden, requiring thoughtful consideration before they show themselves. The point here is that the use of social networking technology has become so routine that clinicians might adopt it mindlessly without carefully thinking through the potential consequences in therapy situations. The results can include unanticipated breeches of confidentiality or the transmission of private information to unintended parties, sometimes leading to severe damage to clients.
What is social networking?
According to The Stanford Encyclopedia of Philosophy (Winter 2012), ‘social networking’ is: “an inherently ambiguous term requiring some clarification. Human beings have been socially ‘networked’ in one manner or another for as long as we have been on the planet, and humans have historically availed themselves of many successive techniques and instruments for facilitating and maintaining such networks. These include structured social affiliations and institutions such as private and public clubs, lodges and churches as well as communications technologies such as postal and courier systems, telegraphs and telephones. When philosophers speak today, however, of ‘Social Networking and Ethics’, they usually refer more narrowly to the ethical impact of an evolving and loosely defined group of information technologies… that emerged in the first decade of the 21st century.”
What are the ethical issues?
Privacy. Possibly the most immediately obvious concern as we consider the use of social media by therapists and their clients is the threat posed to a client’s right and expectation that therapeutic communications and events will remain private and confidential. Just seeing the words “social” and “media” used in the same sentence as “privacy” or “confidentiality” is enough to activate flashing red warning lights.
It should be noted that privacy in a therapeutic setting has two aspects – the privacy of the client and the privacy of the therapist. Both aspects are relevant to the therapeutic process. Ethical principles generally address the former, but rarely do they address the latter. It should be noted that – at least within the current context – the issue of therapist privacy is seen not from the standpoint of the therapist’s own concerns for privacy, but from that of the client’s best interests. In other words, how can an unintentional exposure to the therapist’s private life negatively affect the client?
Most state laws require that psychotherapists maintain confidentiality. That is, they must be sure that the information that is shared with them by clients, including that person’s identity, remains confidential unless the client authorizes the release of that information. This requirement could easily be violated through the use of a website designed for social networking. For example, if one were to accept a request to become a friend of a client on Facebook, the issue of the possible exposure of that client’s identity to others must be addressed. In addition, just what information will be exchanged should also be addressed, because others might be privy to a client’s confidential information.
Boundaries and Multiple Relationships. The second most obvious concern in a discussion of psychotherapy ethics and social media is the potential threat to the maintenance of therapeutic boundaries within the context of a therapy relationship. Boundaries are instrumental in defining relationships. Clear boundaries are necessary in order for both therapist and client to understand the nature and purpose of their relationship with each other.
A closely related issue is the ethical requirement found in most codes of ethics that therapists refrain from engaging in multiple relationships. If it happens that a therapist and his or her client are interacting within a social media environment like Facebook, there is the possibility of a dual or multiple relationship. The following sections are intended to clarify potential threats to boundary maintenance and the avoidance of harmful multiple relationships in the use of social media.
Competence. Competence is an ethical requirement demanded of professionals, by which they are expected to carry out professional activities only within the boundaries of their training, expertise, and knowledge. This includes an understanding associated with various cultural and ethnic factors. Does the world of social networking introduce a new area of cultural understanding and competence? At least for those of us socialized and acculturated in the physical world of the 20th century, cyberspace and its planets Facebook and Twitter are indeed alien environments. We are confronted with different language, different cultural norms, strange denizens, and unfamiliar forms of social interaction. Fumbling though it all untutored, we are likely to encounter unexpected and unpleasant results.
The question of “friending”. According to Keely Kolmes, a San Francisco psychologist, “Some clinicians believe that friend requests from clients should be evaluated on a case-by-case basis, stating that particular treatment issues may make it reasonable to accept some requests. Some feel that declining requests from clients can be perceived as a rejection. Choices on how to manage this may also be influenced strongly by theoretical orientation, age, and cultural contexts. My belief has always been that adding clients as contacts is a big enough threat to both confidentiality and the boundaries of the therapeutic relationship to justify a blanket policy of not accepting such requests.”
The 21st century is only getting under way, and social networking services are still only approaching warp speed. If you are using – or considering using – Facebook or other social networking systems in conjunction with your professional activities, you will need to go much farther with your education than simply reading the ideas discussed in this article.
If you would like to read this entire article and receive two hours of continuing education credit, visit Professional Development Resources at https://www.pdresources.org/course/index/6/1147/Ethics-and-Social-Media
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