Mental Health Professionals on Facebook

By Steven Petrow | The Washington Post

Mental Health Professionals are on FacebookFor the past two weeks, whenever I’ve scrolled through my Facebook newsfeed I’ve come to the section “People You May Know.” The suggestions offered have included relatives, co-workers, some people I don’t even like in “real” life — and my current psychologist. “OMG!” I’ve winced repeatedly at the profile photo of my shrink, who for the sake of his privacy I’ll just call Dr. E.

Still, being the curious sort, I clicked to view his page, which isn’t very well protected from eyes like mine. For starters, there are 12 photos of him available for all the world to enjoy, several of them shirtless and one that had a “friend” of his posting “Woof!” underneath it. I also discovered pictures of Dr. E from high school with two nice-looking young ladies. Although I’ve known he was gay, I started to wonder: Was he bisexual then? When did he come out? I found myself thinking much more about his personal life than any patient should.

Among Dr. E’s Facebook friends was another psychologist, one who seemed to deploy no privacy safeguards whatsoever. Any patient clicking on his Facebook page could see tons of photos, including those of his wedding and honeymoon, and even his attendance at a celebration of “Bush 43’s” last night in office. (That makes it a good bet he’s a Dem, which might be TMI for a GOP patient.) Feeling nosy, I found yet another shrink on Dr. E’s friend list with equally little privacy protection.

At that point I started wondering: Are there no social media best practices for mental health professionals? To my surprise, I discovered that the answer to this question is no. According to a recent article in Academic Psychiatry, “[T]here are no firm guidelines for psychiatrists regarding how to manage information on the Internet.” The authors also highlighted one of the central problems for mental health professionals using social media: “Facebook users commonly list their sexual orientation, marital status, religion, age, hometown, and political affiliation in their profiles, most of which information is not typically shared with patients.”

Before Facebook and Twitter, psychotherapists had varying boundaries regarding what they disclose to patients. Some revealed nothing at all, while others disclosed personal information they thought might help the therapeutic relationship (for example, that they are married, divorced, Jewish or a recovering alcoholic).

Over the course of my adulthood, I’ve had two previous therapists, both of whom divulged very little about themselves in our sessions. Each of them ended up spilling some rather personal beans to me (one unintentionally, the other out of necessity), but neither of these revelations felt as inappropriate as the Facebook page of Dr. E.

Unlike Dr. E, my first therapist never even told me he was gay — a fact that might have reassured me a good bit, since this was the early 1980s, when I was first coming out. He was a Woody Allen lookalike who, every time I’d ask him a personal question, would turn the query back to me, asking, “Why do you want to know?” Mostly, I was eager to learn whether he had a boyfriend or a girlfriend. One night, long after dark, I was in the West Village in New York when I spotted him leaving a gay bar, dressed in a black leather jacket and cap. Silently, he nodded hello. Well, that answered that question, although we never actually discussed it.

“Dr. Woody” and I had had what therapists call an “extra-therapeutic contact” — it may have been awkward, but it was accidental and he had done nothing wrong. After all, even a therapist is allowed to have a personal life.

A dozen years later, I found myself in a new therapeutic relationship. While deeply empathetic, this psychologist also drew strict boundaries between her professional and personal lives — until the day an armed guard showed up outside the office. She explained that her attorney husband had once successfully prosecuted a man who — after being convicted — came to their home and shot him. Now the felon was being released, with no requirement that he stay away from his old nemesis. Thus the armed guard.

Dr. Woody’s disclosure was accidental but important (to me at least); the second therapist’s was necessary but irrelevant (except in that she and her husband ended up going underground, which ended our successful therapeutic relationship). Dr. E’s personal disclosures on social media seem different to me because he was repeatedly presented to me as a peer and not my therapist. I may have been curious, but I didn’t really want to see everything behind that black curtain. Even though I couldn’t stop myself from looking.

I understand that mental health professionals are only human, and they often make the same digital-era mistakes we all do. Just like the rest of us, they need some rules of the road.

While no firm social media guidelines have been adopted by the various mental health professional organizations, the American Psychological Association has published a manifesto of sorts on the topic. In “The Internet’s Ethical Challenges,” Stephen Behnke, director of the APA’s Ethics Office, wrote that “psychologists have special ethical issues they need to think through to determine how this technology is going to affect their work.”

Eric Harris, who serves on a task force on tele-psychology guidelines for psychologists, says figuring out how to use social media can be challenging for mental health professionals: “It would be wrong to say they can’t participate on social networks, but they have more responsibility to think through how they manage their privacy settings. Your psychologist should have made it hard for you to find him.”

“The patient has some responsibility in this, too,” says Harris, a psychologist and lawyer, noting that he would have put the onus on me had I actively sought out Dr. E. on Facebook, sent him a friend request or used Google to determine his political contributions, the tax-assessed value of his house or his genealogy.

But I didn’t. Facebook suggested Dr. E. as a friend because he probably hadn’t really thought about his privacy settings, which allowed the Web site’s bot to find friends and groups we have in common. He’s far from the exception: A University of Florida study reported that only 37.5 percent of medical students and residents use their privacy settings, which Harris told me is probably a good barometer of the problem in his discipline.

The mental health profession is not unaware of this issue. In 2011, Glen Gabbard, a professor of psychiatry at SUNY Upstate Medical University in Syracuse, N.Y., proposed nine “recommended guidelines for maintaining professional boundaries online.” First on the list: “Psychiatrists and other mental health professionals who use social networking sites should activate all available privacy settings.” Three years later, the guidelines have yet to be formally adopted. More than a decade after Facebook exploded across the globe, that’s an unconscionable lapse that needs to be fixed.

In the meantime, I’m going to ask Dr. E. to change his privacy settings so the nice robots at Facebook can’t make the connection between us — or at least they won’t tell me about it if they do. That way, I can stop thinking about his personal life and get our sessions back to what they should be, which is all about me.


Petrow writes the “Civilities” advice column for The Post. He can be reached at and

APA’s Telepsychology 50-State Review & Guidelines

By the American Psychological Association

Telepsychology Review & GuidelinesThe trend toward telepsychology — the use of communication technologies in the provision of psychological services — has the potential to reduce hospitalizations, increase access to mental health care and save lives. But there are also limitations and restrictions on the use of telepsychology. Statutes and regulations governing the provision of telepsychology services vary greatly from state to state.

Over the past few years, a growing number of states have passed or updated laws or rules governing telepsychology practice. The increasing volume of laws pertain to both delivery of and payment for telepsychology services.

In light of these developments, the APA Practice Directorate’s Office of Legal & Regulatory Affairs has updated the Telepsychology 50-state review (previously called the Telehealth 50-state review) to guide psychologists in navigating the regulations and provisions in their state.

Telepsychology 50 state review (PDF, 1.01MB)

At its late July 2013 meeting, the APA Council of Representatives approved new Guidelines for the Practice of Telepsychology. A Joint Task Force on the Development of Telepsychology Guidelines for Psychologists, comprised of members representing APA, the Association of State and Provincial Psychology Boards and the American Psychological Association Insurance Trust (APAIT), was formed in 2011 to create guidelines for the practice of telepsychology.

The new telepsychology guidelines (PDF, 113KB) are available on the APA Practice Organization’s Practice Central website.

If you have any questions, please contact the APA Office of Legal & Regulatory affairs or call (202) 336-5886.

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

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).

Record-Keeping Guidelines from the American Psychological Association

CE Credit: 1 Hour
Target Audience: Psychology Counseling Social-Work Marriage-and-Family
Learning Level: Introductory
Price: $9

Record-Keeping Guidelines from the American Psychological Association

Click on image to view course webpage

Course Abstract:

This is a web-based course requiring an internet connection to access the online reading materials. Course instructions provide a direct link to the public-access online document. This course is based on the record-keeping guidelines published by the American Psychological Association in 2007. The brief course document provides aspirational information regarding the creation, maintenance, sharing, and destruction of records related to psychological services. Course #10-31 | 2007 | 12 pages | 10 posttest questions

Learning Objectives:

  1. Identify the sources of guidelines to record keeping (laws, regulations,professional standards)
  2. Identify the role of the APA guidelines and understand the proper manner for applying them
  3. Describe guidelines for the creation and maintenance of records related to psychological services
  4. Describe guidelines for the protection of the privacy of records related to psychological services
  5. Describe guidelines for the release or sharing of records related to psychological services
  6. Describe guidelines for the destruction of records related to psychological services

About the Author(s):

The American Psychological Association (APA), located in Washington, D.C., is a professional organization with more than 150,000 members, including researchers, educators, clinicians, consultants, and students. The document on which this course is based was compiled and written by members of the American Psychological Association.

Accreditation Statement:

Professional Development Resources is recognized as a provider of continuing education by the following:
AOTA: American Occupational Therapy Association (#3159)
APA: American Psychological Association
ASWB: Association of Social Work Boards (#1046)
NBCC: National Board for Certified Counselors (#5590)
NAADAC: National Association of Alcohol & Drug Abuse Counselors (#00279)
California: Board of Behavioral Sciences (#PCE1625)
Florida: Boards of SW, MFT & MHC (#BAP346); Psychology & School Psychology (#50-1635); Dietetics & Nutrition (#50-1635); Occupational Therapy Practice (#34). PDResources is CE Broker compliant.
Illinois: DPR for Social Work (#159-00531)
South Carolina: Board of Professional Counselors & MFTs (#193)
Texas: Board of Examiners of Marriage & Family Therapists (#114) & State Board of Social Worker Examiners (#5678)