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| Counselors, Clients and Facebook |
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| Feature Articles - Professional Ethics | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Written by Kathleen Parish,LPC and Jeffrey C. Friedman, LISAC | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Monday, 07 February 2011 16:55 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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The explosion of online social media presents ethical challenges for counselors, as illustrated by Rick’s story (below). Rick (a pseudonym) is known in the local community as a gifted and dedicated counselor. A seasoned clinician, Rick’s thriving practice has not prevented him from taking on a number of pro bono clients, and he devotes one evening a week to teaching psychotherapy at the local campus of a nationally known graduate school. For most of his career, his record of professional practice was unexcelled, and both clients and colleagues have always thought him of in the highest of terms. Sadly, Rick is now in a struggle to save his professional license, salvage his reputation in the professional community and stave off a potentially ruinous malpractice suit. Rick’s current problems stemmed from his decision to maintain an ill-defined relationship with his former client on Facebook when, upon returning from a family vacation to Denali National Park in the hinterland of Alaska, Rick learned that this client had committed suicide. Rick became the target of an investigation by the state licensing agency. Upon the successful completion of their two-year counseling relationship, Rick agreed to “friend” his former client as a way of providing her with ongoing support and encouragement. Rick and the former client would regularly message each other through the Facebook website, and Rick would sometimes commiserate with his ex-client and offer her friendly advice. Rick failed to recognize the subtle signs that his former client was relying more and more on their Facebook dialogue, and was beginning entertain the idea that their relationship had romantic overtones. When Rick and his family went on vacation to a place where he had no Internet access, he was unable to read or respond to his former client’s increasingly plaintive and, eventually, desperate Facebook posts. Feeling abandoned, the ex-client sent Rick one final message threatening suicide if he did not respond to her. Getting no response from Rick, the patient ended her life. After her death, the young woman’s grieving parents read the series of posts between their daughter and Rick, and then contacted their lawyer and the state counselor licensing board. Though Rick’s story is apocryphal, it illustrates the fact that the recent explosion of social media sites, like Facebook, is presenting a complex set of safety, ethical and practical challenges for behavioral health clinicians involved in Internet social networking. Mental health professionals are struggling to understand the potential ethical ramifications of electronic social networking as they try to adapt their personal online networking style to the practical and ethical realities of professional clinical practice. Ethical Challenges for Counselors With over 400 million active users, Facebook is, after Google, the most visited website on the Internet. Members spend, on average, nearly three hours a day tending to social networking chores. The brainchild of Harvard dropout Mark Zuckerberg, Facebook began as a college-wide student directory for the Cambridge, Massachusetts- based University, and by 2007, had mushroomed into a business valued at over $240 million. Facebook is generally credited with energizing the social networking boom. As our social lives begin to migrate into cyberspace, difficulties in maintaining proper boundaries in a counseling relationship have grown in scope and complexity. Some clinicians now wonder if contact through social media websites might short circuit the professional distance between counselor and client. Increasingly common use of social media sites – a world in which self-disclosure seems to be the coin of the realm – is creating what some are calling a professional identity crisis, and forcing behavioral health clinicians to reassess the boundaries between their professional lives and digital identities. As clinicians, what is our responsibility to protect the privacy of these individuals when they may be unable to do it for themselves? This is especially true in cases of clinicians revealing too much information too broadly, or where the online posting of photos or sensitive personal information might create an impression that is at odds with their professional persona. Just how much personal data about their clinician – information like sexual preference or political and religious views – can a client tolerate before therapeutic rapport becomes strained? And who among us would want current or former clients to see potentially embarrassing snapshots of us taken during college-era fraternity or sorority rush week or beer-fueled homecoming bacchanals. For that matter, how much do we want our professional colleagues and clinical supervisors to know about our personal lives? Attorney Robert Wilson of the Turley Law Firm has examined the risks inherent in socializing on Facebook, and offers advice on keeping the Facebook experience enjoyable and safe. He advises Facebook users to “… keep your house clean” by not posting (or allowing family or friends to post) embarrassing information or photos that compromise one’s professional image, and regularly auditing one’s Facebook page for any potentially damaging words or images (Wilson, 2009). Wilson also cautions users not to place personal information (including date of birth and phone numbers) on their Facebook site, and moreover warns users not to expect that anything posted on social media sites will remain private for long. Wilson reports that he has “personally seen instances where parties to a lawsuit and witnesses have posted items on their Facebook site [that were] subsequently used later in a job interview or in a deposition.” Another risk inherent in online social networking is that it might imply an invitation to current or former clients to enter their therapists personal lives. The potential that ethical conflicts might sprout in the fertile ground where our personal and professional lives intersect is becoming hard to ignore. Many questions concerning the legal, professional and ethical obligations that might flow out of online counselor/client interactions are yet unanswered. Clinicians also wonder if including a client in their Facebook network might encroach on the client’s right to privacy. Might “friending” violate state and federal regulations regarding counselor/client confidentiality? Similarly, “friending” a current or former client might send a confusing message to the client and morph a helping relationship into one of more mutual disclosure and support. Others may view the “friending” of another client as a preferential relationship with that client. Though it has yet to explicitly address issues related to social media, the American Counseling Association (ACA) Code of Ethics reminds professional counselors that they have a responsibility to “take precautions to ensure the confidentiality of [client] information transmitted through the use of computers, etc.” (ACA, 2005). The National Association of Social Workers (NASW) Code of Ethics also cautions practitioners not to “solicit private information from clients unless it is essential to providing services or conducting… evaluation or research.” In addition, clinical social workers are prohibited from “discuss[ing] confidential information in any setting unless privacy can be ensured” (NASW, 2008). The recent explosion of social media sites, like Facebook, is presenting a complex set of safety, ethical and practical challenges for behavioral health clinicians involved in Internet social networking. The ACA Code of Ethics joins with the NASW in warning against a nonprofessional counselor-client relationship, and reminds practitioners that such relationships “should be avoided except when the interaction is potentially beneficial to the client” (ACA, 2005). Furthermore, the ACA mandates that counselors who do engage in non-professional relationships “must document in case records … the rationale for such an interaction” (ACA, 2005). The consequences of overexposure appear to spread in all directions. Those familiar with the workings of electronic social media recognize the fact that they have little or no control over how their “friends” manage their own personal privacy settings. Unwittingly, a counselor using online social media may expose others within his or her network to the rants and photos of possibly unstable current or former clients. Would we really want our mother/sister/young niece to view what might be, for them, disturbing words or images? As clinicians, what is our responsibility to protect the privacy of these individuals when they may be unable to do it for themselves? A counselor who posts his or her address, phone number and personal e-mail on electronic social media may even be at risk for “cyber stalking” by unstable or potentially volatile clients who may threaten the counselor’s physical safety. Rick’s story highlights yet another potential problem for clinicians involved in online socializing — the possibility that clients with poor boundaries might try to engage the counselor in therapeutic dialogue on Facebook. And if this happens, to what extent is the professional therapist legally obligated to act on any information posted on electronic social media sites? Attorney Wilson advises us not to accept any friend requests. He references instances where “… sex offenders [are] creating fake accounts to gain access to you online.” Says Wilson, “If you do not know the person, then do not add them to your accepted friends” (Wilson, 2009). Facebook Safety Tips for Counselors • Think twice (or even three times) before engaging in Facebook friendships with current or former patients/clients. • This also applies to engaging in Facebook friendships with family members or friends of clients (former or current). • Adjust Facebook privacy settings to allow only “friends” to view your profile, status, photos, posts, etc. Even choosing the option “friends of friends” can leave counselors susceptible to ethical violations. Do consider making your profile unsearchable as a privacy setting. • Do not accept friendship requests from persons unknown to you, even if you share mutual friends. • Do not post your e-mail address, phone number, date of birth or physical address on your Facebook page. • Do have honest communication with new patients/clients about not engaging in online relationships with them via Facebook as part of an overall review of the therapeutic contract. • Use great care in selecting photos of yourself for display on Facebook. Remember that photos of yourself from past years can cast suspicion on your otherwise stellar reputation. • Use discretion when joining certain groups, fan clubs or specialty pages. This can open up your personal information to others who have also joined these pages. • Avoid discussing confidential, work related matters on your Facebook page with friends, even in general terms. Some in the field are even concerned that licensing boards, accreditation agencies, insurance companies and even government agencies may already be monitoring the data of electronic social media for signs of professional unsuitability or illegal activity. Already, lawyers involved in pressing professional malpractice actions routinely search social media pages for information that may compromise the credibility of a clinician that is the target of a lawsuit. And, recently, a Canadian psychotherapist bound for the United States was turned away at the border – and permanently prohibited from entering the United States – after an Internet search by customs agents revealed a scholarly article the man had written – over 30 years ago – on the use of LSD in a clinical setting (Rosen, 2010).Although most state licensing agencies have yet to codify policy regarding social networking behavior of their licensees, clinicians might be well advised to think long and carefully before venturing into the rapidly evolving world of Internet social networking – a world where that which is posted may be impossible to ever fully erase. Care should also be taken about choosing what personal information a counselor puts into cyberspace – lest an indiscrete posting or photo comes back to haunt the poster months or even years after the fact. In the course of researching this article, the authors came across one story after another about how the “friending” of a current or former client turned out badly for the behavioral health clinician who was injudicious in their social networking practice. The perils of the digital age are many and varied. Tread lightly and carefully. A strong professional identity is a precious thing – one that is hard to recover if ever damaged. Kathleen Parrish, LPC is clinical director of Cottonwood Tucson, an inpatient behavioral health treatment facility located in Tucson, Arizona. Aside from supervising the adult clinical team at Cottonwood, Kathleen also serves as clinical supervisor of Cottonwood’s Sweetwater 90-day adolescent female behavioral health treatment program. Kathleen has written articles for Addiction Professional and AZ Together magazines. She may be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . Jeffrey C. Friedman, LISAC is a primary therapist at Cottonwood Tucson where he works with chemically dependent and disordered gambling patients. Jeff has also conducted workshops on the treatment of behavioral health disorders in places as diverse as Dublin, Ireland and Hong Kong. A number of articles written by Jeff have appeared in Counselor magazine and other publications. He may be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it . References ACA. (2005). ACA Code of Ethics. American Counseling Association. Alexandria, Virginia: American Counseling Association. NASW. (2008). Code of Ethics of the National Association of Social Workers. The National Association of Social Workers. Washington, D.C.: National Association of Social Workers. Rosen, J. (2010). The End of Forgetting. The New York Times Magazine. July 25, 2010. Wilson, R. (2009). 10 Facebook Safety Tips – How to Protect Yourself. The Turley Law Firm. www.turleylawfirm.com/library/10-facebook- safety-tips.cfm.
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I really loved this article as I am also taking an Ethics course. I never