How Should Therapists Handle “Friending” Requests?

Course excerpt from Ethics and Social Media

The Phenomenon of “Friending”

Friending Request from ClientA “friend” used to be an individual of one’s personal acquaintance, with whom a sense of liking, trust, and camaraderie had been built over some period of mutual experience and interaction. Many people considered themselves fortunate if – over the period of a lifetime – they were able to count a handful of others among those they considered to be friends.

With the advent of Facebook, that concept has morphed into something that may or may not bear any resemblance to the original definition. In many cases, people who are friends on Facebook were personal real-life friends before joining up on Facebook. In other cases, new friends are made online, without the benefit (or bother) of any face-to-face interaction. In still other cases, individuals spend a great deal of time and effort collecting “friends” online for the sake of amassing a very large audience for their postings.

In some cases, these numbers are quite extraordinary. According to a survey by the Pew Research Center (2014), the average number of friends a person has on Facebook was 338. A generational ranking revealed – not surprisingly – that number of Facebook friends was inversely correlated with one’s age. Millennials (age 18-29) averaged 300 friends (a quarter of these young users had more than 500 friends in their network), Gen Xers (age 30 – 49) 200, and Younger Boomers (age 50 -64) 75. People over the age of 65 average 30 friends.

To Friend or Not to Friend

One of the more complex challenges facing contemporary therapists (at least those who use Facebook) is the question of how to respond when receiving a friending request from a client. It is the arrival of this simple electronic message that precipitates a cascade of questions concerning a broad spectrum of ethical issues from privacy and confidentiality to multiple relationships and clinical competency. Zur (2012) states it this way:

“Currently, more than 900 million people around the world and more than 157 million in the United States [these numbers are already outdated] have Facebook pages, and at least some of them may be your clients. Clearly, the issue of when, or whether, to use Facebook touches on just about every clinical and ethical issue of importance to therapists, particularly issues relating to boundaries and dual relationships. Should you even have a Facebook page, and if so, how much of your private life should you show? Who should see what? Should you use Facebook’s privacy settings to distinguish what you show among colleagues, best friends, family members, and old, new, and potential clients? How do you respond to clients who want to ‘friend’ you?”

These questions are answered in different ways by different therapists. Kolmes (2009) offers this view:

“Inviting clients to your personal profile can also be perceived as inviting them into your personal life. Unless you utilize very strict privacy settings on your profile, those who become your ‘friends’ can post and view messages posted to your Wall, they can view your photo albums and read the comments on these albums, and they can see and interact with your other ‘friends.’ This can send mixed messages to clients, especially if they are unclear about therapeutic boundaries to begin with. If you would never think of inviting a client to a cocktail party at your home with your friends and family present, then you may want to think twice about inviting them to be your friend on Facebook (or approving their friend requests). It is the online equivalent of inviting them into your social circle.”

Laura Hahn, a counselor in private practice, suggests that therapists refrain from friending clients on Facebook. “Make it a policy by adding a statement to your informed consent documentation and inform your clients up front. Counselors who find clients being overly interested in the counselor’s personal life and conducting intrusive online searches can explore that topic with the client in therapy” (in Shallcross, 2011).

Questions for Psychotherapists to Consider Before Responding to Clients’ Friend Requests

It is useful – probably even necessary – for a therapist to spend some time pondering the friending issue before plunging into the world of digital friendship. On the Zur Institute website (http://www.zurinstitute.com/socialnetworking.html) there is a list of questions for therapists to consider as they face this decision.

Learn more: https://www.pdresources.org/course/index/6/1147/Ethics-and-Social-Media

Ethics and Social MediaEthics and Social Media is a 2-hour online continuing education (CE) course that examines the use of Social Networking Services (SNS) on both our personal and professional lives. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on SNS like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication? The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy. Course #20-75 | 2016 | 32 pages | 15 posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).

Texting or Friending Patients Frowned Upon in New Professional Guidelines

By Robert Preidt

Doctors Urged to Refrain from Social Media Contacts With PatientsIn this age of texting, tweets and Facebook “friends,” doctors should show restraint when it comes to reaching out to patients through social media, new guidelines say.

Updated recommendations for online ethics from the American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB) say the key is drawing a clear line between professional life and social life.

If physicians fail to do so, the “potential dangers are confidentiality concerns, replacement of face-to-face or phone interaction, and ambiguity or misinterpretation of digital interactions,” the American College of Physicians said in a news release.

Some of the key recommendations:

  • Doctors should not contact or “friend” patients through personal social media such as Facebook.
  • Text-messaging should not be used for passing along medical information except when there is patient consent. Even then, doctors should use “extreme caution,” the guidelines said.
  • Careful judgment is needed when a doctor is contacted through email or other electronic communications by someone who is seeking medical advice but has had no previous contact with the doctor. In such situations, it is usually best for the doctor to encourage the person to schedule an office visit, or, in the case of an urgent concern, to go to the nearest emergency department.
  • Doctors should establish an online professional profile so that it appears first during an online search, instead of a review of the doctor from a physician ranking site. This can provide more control, so that the information read by patients is accurate.
  • Medical trainees need to be careful about what they post online, or they could damage their future careers.

“It is important for physicians to be aware of the implications for confidentiality and how the use of online media for non-clinical purposes impacts trust in the medical profession,” Dr. Humayun Chaudhry, president and CEO of the FSMB, said in the news release.

The policy paper appears online and in the April 16 print issue of the journal Annals of Internal Medicine.

SOURCE: American College of Physicians, news release, April 11, 2013

http://www.nlm.nih.gov/medlineplus/news/fullstory_135870.html

Related Online CEU Course:

Ethics and Social MediaEthics and Social Media is a 2-hour online continuing education course for psychologists, counselors, social workers, and MFTs. Is it useful or appropriate (or ethical or therapeutic) for a therapist and a client to share the kinds of information that are routinely posted on Social Networking Services (SNS) like Facebook, Twitter, and others? How are psychotherapists to handle “Friending” requests from clients? What are the threats to confidentiality and therapeutic boundaries that are posed by the use of social media sites, texts, or tweets in therapist-client communication? The purpose of this course is to offer psychotherapists the opportunity to examine their practices in regard to the use of social networking services in their professional relationships and communications. Included are ethics topics such as privacy and confidentiality, boundaries and multiple relationships, competence, the phenomenon of friending, informed consent, and record keeping. A final section offers recommendations and resources for the ethical use of social networking and the development of a practice social media policy.

CE Information:

Professional Development Resources is approved as a provider of continuing education by the Association of Social Work Boards (ASWB #1046); the National Board of Certified Counselors (NBCC #5590); the American Psychological Association (APA); the National Association of Alcoholism & Drug Abuse Counselors (NAADAC #000279); the Florida Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346); the California Board of Behavioral Sciences (#PCE1625); the Texas Board of Examiners of Marriage & Family Therapists (#114); the South Carolina Board of Professional Counselors and Marriage & Family Therapists (#193); and the Ohio Counselor, Social Worker and Marriage & Family Therapist Board (#RCST100501).