Social Media and Therapy Clients

It finally happened…

I have profiles on YouTube, Facebook, LinkedIn, Digg, Reddit, Technorati, Ning, Squidoo, XING, Answers.Yahoo, GodTube, MySpace, Yedda, Furl, Blogger, StumbleUpon, del.icio.us, Yelp, and Google Talk, to name a few. Most of these I hardly use. Some of them I’ve been on once to create the account and only remember it when I receive newsletters in my email inbox, which I then unceremoniously delete.

My students and colleagues have been finding me online for a few years now, so I’m used to getting the occasional “friend request” from someone I teach or work with. However, last week I received a Facebook friend request from Cecil, a 20-something British-American therapy client*. I immediately considered declining the request, but stopped short.

“I am trying to establish trust and rapport with Cecil,” I thought. “If I decline his request to join such a non-exclusive network, could it harm our therapeutic rapport?” Truly, I would accept a friend request from a stranger’s grandmother’s labradoodle without thinking twice—so why not Cecil?

Potential problems

Adding Cecil as a “friend” on Facebook will grant him access to mostly benign information: a few of my photos and some biographical information. However, it will also allow him so see comments and photos of the students, colleagues, family, friends (and pets) I have added before him. I must consider, first, that perhaps Cecil has not considered what it will be like to view my friends and family – people who have a personal relationship with me that he does not, but one that he might desire himself. Second, Cecil may regret being “in network” when he realizes that “my” people can see his profile, which could be a breach of confidentiality. Third, Cecil may have unspoken expectations about our online connection that I cannot accommodate, such as:

• Will Cecil expect me to write back and forth with him?
• Will Cecil want to post on his webpage?
• Will Cecil want me to NOT post on his webpage?
• Does Cecil expect, or hope, to be added to my “Top Friends” list?

Fourth, I might not be able to respond adequately to inquiries from others who ask about the British guy (Cecil) who is now in my network, and who is (possibly) commenting on my webpage. Fifth, I might be allowing Cecil to use our relationship as a friendship, which could hinder our therapeutic goal of him developing relationships outside of counseling. Sixth, including Cecil in my network could blur professional-personal boundaries.

For all of these reasons, I have decided that I need a policy, not just for Cecil, but for any client who requests an online connection in the future.

Online Networking Policy

1) Never solicit a connection.
A connection severely jeopardizes client confidentiality, so should never be initiated by the therapist.
2) Discuss with the client his/her reasons for requesting a connection.
Is the client using the counseling relationship as a friendship? Does he or she want to be a bigger part of your life? Addressing motivations could be good “grist for the mill” in the therapy process.
3) Address the risks and benefits.
Clients may underestimate the potential for negative emotions they might feel being in your network. Also, address client expectations – what purpose does the client believe the online connection will serve?
5) Clean up your profile.
Minimize the risk of blurring professional-personal boundaries by making your account less personal. Some time ago I decided this was a necessary endeavor: Gone are the pictures of my sisters and me making faces at the camera. Gone is the survey that says my “superhero personality type” is the Green Goblin. Many of my new accounts are for my counseling practice, not me personally. I considered making two profiles for each website (one personal, one professional), but rejected the idea when realizing there is nothing to prevent my clients from soliciting a connection with the “wrong” profile.

Today, Cecil is still on my “friend request” pending list, neither declined nor approved. I might approve him, but not before we talk.