navigating social media as clinicians in the 21 st century

Ashley Smith & Andrea SkaflenJames Madison University

February 19, 2011

What is social media?“Social” – refers to instinctual needs humans

have to connect with other humans“Media” – what we use to make connections with

other humans“Social Media” – how we can use technology

effectively to reach out & connect with other humans, create a relationship, build trust

Media used for social interaction2 way communication - interactive dialogue

Types of Social MediaWritten wordTelegraphTelephoneRadioTelevisionEmailWebsitesPhotographsAudioVideoMobile phones (cell

phones)Text messaging

Picture-sharingV-logs (video blogging)Wall postingsMusic-sharingWeblogsSocial blogsInternet forumsPodcastsSocial bookmarkingVirtual game worlds

(video games)Virtual communitiesSocial networking

Social NetworksExample

s:FacebookTwitterMyspaceLinkedInSkype

Social networking accounts for 22% of all time spent online in the U.S.

Twitter averages almost 40 million ‘tweets’ per day

1 in 4 people over the age of 65 use social networking sites

“There are over 200 active sites using a wide variety of social networking models today.”

Possible situations counselors might encounterDiagnosing clients with internet, gaming, etc addictionHelping a parent understand how technology use is

negatively impacting their child’s lifeProviding psycho-education about dangers of online social

sites – stalkers, sexual predators, bullies etcAdults – might be new to technologyChildren – might be oblivious to dangers

Client’s personal information available onlineCounselor’s information available online

Personal use Professional use

Dilemma of being friend requested by a clientUsing technology in counseling services

Social Media Revolutionhttp://www.youtube.com/watch?v=NB_P-

_NUdLw&feature=related

Communicating with ClientsFace to face

In the roomVia computer

VerballyOver the phone

Written wordEmail or letterChatting or texting

What is social networking?“It's the way the 21st century

communicates today.”A social network service is an online service,

platform, or site that focuses on building & reflecting social relations among people who share interests &/or activities

Essentially consists of a representation of each user (profile), social links, & other services

Most are web based; interact through internet, email, instant messaging(chatting), or phone applications

Dangers of Posting Pictures Onlinehttp://abclocal.go.com/wabc/video?

id=7621105

TelephoneWork phone numberPersonal phone numberTextingHotlines

Provide free, anonymous and immediate helpOffer information, emotional support, and

referrals234 million people over 13 years old used mobile

devices in Dec 2009

TelephoneReduces response time Increases accessibilityAgencies should have emergency services

available 24 hours a day, 7 days a weekTelephone also integral part of traditional

counselingAdjunct to face-to-face work with clientsFew professionals have training in this area though

Client is in complete control of the duration of the conversationClient can hang up when they want

Suggestions for Telephone Communication with Clients

Track moreTune into nonverbal cuesAppreciate the intimacy of telephone

communicationUse your body as you talkTake notesHave vital resource information near your

telephoneMaintain contact

InternetEmailSkypeChattingSocial Networks (Facebook, Twitter,

LinkedIn)“Self-help” websites, blogs, and chatrooms

InternetMichael Feeny (2001) stated that a large

number of online counseling and therapy sessions will be taking place every day in the not too distant futureCurrently, about 5,000-25,000 online contacts

between counselors and clients take place daily

Telephone & InternetLike using a telephone, most internet

communication does not involve visual cues, however that may be an advantageComfort and privacy of client’s homeCan take whatever time needed to compose

messages (email)Because client isn’t seen, may feel sense of

anonymity and be less inhibited and candid

Suggestions for Internet Communication with Clients

Use emoticonsUse acronymsUse emotional bracketingOffer descriptive immediacyBe aware of ethical concerns and legal issues

CrisisMost fundamental task – make yourself

known as someone who can help in a crisisIn person, in writing, over the phone, or

through the internet – making contact with person in crisis is essential step in crisis intervention

Initial session vs Established RelationshipHow do you think an established relationship

would influence efficacy of online or telephone communication with clients?Rapport already establishedTrusting relationship built

AccessibilityHow accessible should counselors be?

24 hours a day; 7 days a week?Monday-Friday 8-5?

In what ways should counselors be available?Texting?Voicemail?Pager number?Personal telephone number?

BoundariesAppropriate to text client?Policies about emailing clients?Phone etiquette Available 24/7?

Confidentiality Difficult to maintain

People can overhear or accidentally see conversations

How could the information be used?How do you keep records?Could a transcript of a session be called into court?

If using a type of “real time” chat or e-mail how do you limit the risk of third party knowledge of an online sessionencryption—how much does this limit risk?

Ethical Framework for Use of Social Media Practitioners are mindful that social media

activity can blur the boundaries between personal & professional lives

Applicable ethical principles relevant to clinical care & social media:ConfidentialityMultiple RelationshipsTestimonials Informed ConsentMinimizing Intrusions on PrivacyInitiating Professional RelationshipsDocumenting and Maintaining Records

Ethical Framework continued…Social media interactions which relate to

ethical principles:Personal vs. professional behavior on the web

for practitioners Friend and follow requestsSearch enginesInteracting using email, instant messaging, etcConsumer review sitesLocation-based servicesOnline treatment

ACA Code of Ethics (2005)A.12. Technology Applications

Counselors inform clients of benefits & limitations of using information technology applications in the counseling process Include but are not limited to computer hardware, software,

telephones, Internet, online assessment instruments & other communication devices

When providing technology-assisted distance counseling services, counselors determine that clients are intellectually, emotionally, & physically capable of using the application & the application is appropriate for the needs of the clients When technology-assisted services are deemed inappropriate,

counselors consider delivering services face to faceCounselors ensure that use of technology does not violate laws

of any local, state, national, or international entity

Code of Ethics continued…As part of the process of establishing informed consent, counselors do

the following: Address issues related to difficulty of maintaining confidentiality of electronically

transmitted communications Inform clients of all colleagues, supervisors, employees who might have access to

electronic transmissions Urge clients to be aware of all users including family members & fellow

employees who have access to any technology clients may use in the counseling process

Use encrypted websites and email communications to help ensure confidentiality When encryption is not possible, notify clients & limit electronic transmissions to

general communications – not client specific Inform clients if & for how long storage of records maintained Discuss possibility of technology failure & alternate methods Provide clients with emergency procedures (calling 911 or crisis hotline) if

counselor not available Discuss time zone differences & cultural or language differences that might

impact service delivery Inform clients when technology assisted distance counseling services not covered

by insurance

Scope of PracticeIndicates the specific area to which a

practitioner may practiceMay also define where a practitioner may

practiceUnderstanding boundaries & limitations of one’s

specific disciplineUnderstanding specific laws or ethics within one's

own discipline or geographic locationRespect specific laws of potential client’s

geographic locationCompetence

Training and Supervision of Online Counseling Work

Limited course work regarding the specifics of online counseling work to ensure competency and efficacy through online medium

Limited number of Supervisors available with experience in online counseling work to provide appropriate supervision of online counseling work

EfficacyHow effective is it to communicate with

clients via social mediaRESEARCH STUDIES?

Client’s Access to Counselor’s Personal Info“Prior to calling or interviewing their potential

psychotherapists, consumers are likely to search for the therapists Facebook profile or page, or other social networking profiles” (Zur, 2009)

Through social networksHow much personal information should be

available for public view?Pictures, interests, hobbies, phone #, address,

communication with others (Facebook wall, etc)

Counselor’s Profile Related to Professional Practice

Websites available to the public should include:Crisis intervention informationCounselor contact informationCounselor education, license/certification

informationTerms of use, privacy policy, & social media

policyEncrypted transmission of therapeutic &

payment informationInformed consent process

Counselor’s Access to Client’s Personal InfoPictures, interests, hobbies, communication

with others (Facebook wall, etc)Previewing client’s information before initial

meeting (“scoping out client”)Gain access to client’s information not

expressed in sessions“Checking up” on client after sessions have

been terminated

Digital “Natives” vs Digital “Immigrants”

Things to be aware ofCautions to remind children/teens ofCautions to remind parents ofUnderstanding purpose of social networksUnderstanding dangers of social networksPrivacyCyber-bullying

Themes Counselors Might AddressTrollingOnline bullying (Cyber-bullying)Lack of interpersonal interactionBarrier between kids/teens and parentsInappropriate picturesThreatsTeachers and students “friends” online

Ways Social Media will Change Mental Health Care

Changing how we communicate & define “relationship”

Professionals will collaborate more – more comfortable communicating via social outletsAlso learn to consult & collaborate more on cases

(careful with confidentiality), share research information, & become partners on treatment programs

The stigma & isolation of mental illness could decreaseOnline patient advocacy sites allow people to discuss

mental health issues with one another – share similar experiences & provide suggestions for coping

Ways Social Media will Change Mental Health Care continued…

Increased demand for high quality mental health careSurge of “e-clients” – those who are “plugged in” &

research, advocate, & communicate onlineCurrent & potential clients asking providers

educated questions about their expertise, treatment philosophy, & expected outcomes

Stay up-to-date on what’s going on in your specialty – don’t want a client quoting research you should know about

Ways Social Media will Change Mental Health Care continued…

Allow us to create & provide simple follow up programs & protocols that can be sent out to people daily, weekly, or monthly via email, text, audio, or videoReminders to take medication, exercise, eat right,

go to bed on time, use a journal, etcGreater ability to create treatment programs that

clients want & needAllows us to listen & discuss with consumers what

they would like in terms of service structure & offerings

Policy for Social MediaFeel free to provide a policy for clients regarding:

FriendingFanningFollowingInteractingUse of search enginesBusiness review sitesEmail

Example of Keely Kolmes, Psy.D.“My Private Practice Social Media Policy”

Overall Benefits/AdvantagesConvenience

Client feels comfort in own chosen location (home, work, etc)Transportation not required to speak with counselor

Reach Accessibility Usability Recency

Instantaneous responses; participants determine delay in response

Permanence Client able to read & reflect upon counselor’s words multiple

timesEspecially useful in crisis situationsHelpful in conjunction with face to face counseling

Overall DisadvantagesTechniques difficult to employ through social

mediaNon-verbal gestures

Confidentiality difficult to maintainClients might prefer to remain anonymous

How do you know you are talking to who they say they are?

How do you collect payment from someone you don’t know?

Valid evidence supporting efficacy of cyber-counseling is hard to come by

Things to keep in mindSocial media offers valuable tools and resources

which can support face to face counselingIf you want to use social media, remember to

prepare the client - inform them of appropriate expectations

It is important for each counselor to decide what the personal advantages & disadvantages are of using social media in their practiceAlso keep in mind your organization’s policy (if

you do not have a private practice)

References American Counseling Association. (2005). ACA Code of Ethics. Retrieved from www.counseling.org Barnett, J. (2005). Online counseling: New entity, new challenges. The Counseling Psychologist,

November (33), 872-880. Barnett, J., Levahot, K., Powers, D. (2010). Psychotherapy, professional relationships, and ethical

considerations in the MySpace generation. Professional Psychology: Research and Practice, (41), 160 –166.

Echterling, L., Presbury, J., & McKee, J. (2005). Crisis intervention: Promoting resilience and resolution in troubled times. New Jersey: Pearson Education, Inc.

Giurleo, S. (2010). 5 ways social media will change mental health care. Retrieved from http://socialmediafortherapists.com/social-media-will-change-mental-health-care/

Kolmes, K. (2010). Ethical framework for the use of social media by mental health professionals. Retrieved from http://www.onlinetherapyinstitute.com/ethical-framework-for-the-use-of-social-media-by-mental-health- professionals/

Kolmes, K. (2010). My private practice social media policy. Retrieved from http://www.drkkolmes.com/docs/socmed.pdf

Mallen, M., Rochlen, A., Vogel, D. (2005). The practical aspects of online counseling: Ethics, training, technology, and competency. The Counseling Psychologist, November (33), 776-818.

Walz, G. (2001). Cyber-counseling: A point of view. Retrieved from http://www.nbcc.org/Assets/Newsletter/Issues/winter01.pdf

Wikipedia (2011). Social network service. Retrieved from http://en.wikipedia.org/wiki/Social_networking Wikipedia (2011). Social media. Retrieved from

http://en.wikipedia.org/wiki/Social_media#Communication (n.d.). What is social media? Retrieved from http://static.managementboek.nl/pdf/9780470623978.pdf (n.d.). To accept or not to accept? Retrieved from http://www.zurinstitute.com/socialnetworking.html