Knox, S., Connelly, J., Rochlen, A.B., Clinton, M., Butler, M., & Lineback, S. (2019). How therapists navigate Facebook with clients. Training and Education in Professional Psychology. Advance online publication. https://doi.org/10.1037/tep0000267
Social media networks like Facebook, Twitter, and LinkedIn are widely used in the United States and allow for new methods of communicating (posting, sharing, liking, friending) that may pose unique ethical and practical risks for psychologists and their patients. In this qualitative study, the authors interviewed eight mental health professionals (six of whom were psychologists) to examine how they approach social media with their patients.
The researchers concentrated on Facebook to ensure consistency across participants and asked each clinician to focus on a specific significant Facebook event (i.e. requests to become “Facebook friends”) with a patient they had seen for at least five sessions within the past two years. Most commonly, issues arose with patients who had either sent a friend request to the clinician or to a close family member of the clinician, or with patients who had sent private messages to the clinician through Facebook. Sometimes, during treatment, patients referenced personal information they obtained about the therapist through their Facebook connections (such as on the therapist’s spouse’s profile).
In such situations, study participants typically explained to their patients why they could not be Facebook friends, citing professional responsibilities and the lack of confidentiality. The consequences of the events/discussions were generally positive. Participants felt that they were able to communicate that appropriate boundaries between patients and clinicians provide the most therapeutic environments for their patients.
These discussions also prompted participants to clarify and strengthen their social media policies and practices. There were negative outcomes as well. Some patients were embarrassed or ashamed for seeking Facebook contact with their therapist; others felt hurt by the perceived rejection.
Based on their own experiences, the clinicians offered advice for their colleagues on social media. Generally, this included implementing strict and consistent policies regarding social media contact and disclosing this information upfront. A few participants also recommended that therapists be “careful and professional” on social media, suggesting that they change their profile names if they do not want patients to locate them.