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ECM8495 - Ethical Considerations of Practice in the Age of Social Media and Electronic Communications presents:


Developed by Susanne Riemer, LICSW
and Charles D. Safford, LCSW

Susanne Riemer, LICSW has over thirty years of experience as a clinical social worker. She has served for over a dozen years in agency development, leadership and supervision in public and private mental health organizations, including as supervisor of a field placement program for undergraduate and graduate social work students, and as a trainer and supervisor for staff preparing for licensure exams. She is a member of NASW and the Equine Assisted Growth and Learning Association (EAGALA).

Charles D. Safford, LCSW is the President of He has over thirty-five years of clinical experience and over two decades of experience in training and training development.


This course may not be utilized without first making proper payment. Entering this course in an unauthorized manner would represent an ethical violation. 

This course is designed for clinicians at all stages of their career.

Course length: 3 contact hours in ethics

This course is the copyrighted property of and may not be copied in part or in entirety without the express written permission of For information on how to secure permission to use this course or any part of this course, contact us at:


The objective of this course on ethics is to help the mental health clinician understand some key issues and concerns related to the use of social networks by mental health clinicians. When the trainee completes this course, he or she will:
- Define online social networking: its features, controls, uses, and misuses.
- Apply the role of online social networking in clinical practice in advancing professional, organizational, and therapeutic goals.
- Identify ethical considerations inherent in professional social networking.
- Identify the risks involved in using social networking sites.
- Grasp emerging considerations of privacy and informed consent as they relate to electronic modes of communication with clients. 












A profession as important and complicated as the field of mental health must be continuously reinventing itself in order to adapt to changes in the lives of the people whom the profession serves. Any ethical position taken by a professional in this field must ultimately be supported by a knowledge base that is both current and relevant.

This means that the key themes of the time in which people operate must be identified and understood. This task becomes more difficult – but no less essential – during periods of time when the pace of change and adaptation accelerates. As we begin to examine one area of change that is having enormous impacts on the profession, let’s also take some time to examine the larger picture. On the slide that follows, you will see some information on the key themes of the 21st century that are relevant for the field of mental health.

¥ The ascendance of the market based ethos and the retreat of the service based ethos
¥ The Third Wave and the rise of social media, with the benefits and drawbacks of technology
¥ Generational differences concerning ideas of privacy and shared space
¥ The movement towards a minority majority population and the substantial increase in diversity
¥ The movement towards deconstructionism and the movement away from shared culture towards more individually defined senses of culture
¥ Revised ideas about what constitutes mental health and living a “good life”, and the development of new modes of providing care for supporting health, including distance counseling models
¥ A substantial increase in the development of new treatment models and the knowledge base for mental health, including rapid advances in neuroscience
¥ The increase in polarization between population segments and changing ideas about what constitutes the “American ideal”

Each of these areas is deserving of a thorough examination on the part of the people who work in mental health, because each of these areas has implications for the delivery of services in the 21st century. The focus of this course, however, will concentrate on 1) the ways in which rapid advances in communication capabilities are reshaping how mental health services can be delivered and 2) how the existence of more rapid and more expansive communication creates fundamentally challenges to finding the correct balance between privacy and interconnectedness.

The challenge in finding this balance highlights some of the ongoing tensions between a market based culture – in which the primary forces advocate for the production of ever more goods and services in search of profits and financial gain – and the service based culture – in which organized groups seek to operate in the service of the common good and advocate for the rights and welfare of individuals, particularly those who are more vulnerable.

In the age of information, information itself is a commodity. The personal information of individuals can be utilized by increasingly sophisticated computer programs to identify ways to increase influence over people’s choices of which products to buy. When any person is online, moving from internet site to internet site, each movement may be tracked, generating information that is compiled and then distributed so that marketing efforts by corporations can be more effectively and efficiently tailored to what is know about each person’s tastes.

This represents a challenge to several core principles in the field of mental health: respect for the privacy of the client; respect for the autonomy of the client; and non-exploitation of the client. Because emerging modes of communication with clients will transpire within the communications systems offered within the market based ethos, each clinician must understand that risks and dangers operate alongside the increased capabilities. That is the central driving theme of this course.

Resolutions to these kinds of problems are still emerging because these issues are still so new. It was just the mid-1990s, about a quarter of a century ago, when the internet age fully came of age. In August 2003, five northern Europeans released a small but ambitious telecommunication application software called Skype, and about a half year later, an obscure college freshman at Harvard University launched a small application that would turn into the company Facebook.

These innovations – and a whole host of new communications applications built upon that foundation – have radically reshaped the entire landscape of the world and how it interconnects. Online social networking is the way that many people in the 21st century communicate. The most popular online social network, Facebook, now claims more than a billion users around the world, approximately 1 out of every 6 people on the planet. Twitter, with its short message format, has exceeded the 200 million user mark. It is thought that these social media tools may have at least partially contributed to the success of recent revolutions in the Middle East.

There are also tools of this sort in the business sector. The online social network most often used for business purposes is LinkedIn, which now claims over 100 million users. Users can communicate with other people in their network, post job openings, facilitate introductions to other members, and engage in other networking activities that support their professional life.

Some professionals, professional associations and businesses also create their own social network sites, allowing for more freedom in promoting their business, company or profession. The world of interpersonal communication is not what it was even twenty years ago, and what it means to be part of a social network has been altered significantly.

The capacity to communicate in just an audio based format (i.e., the phone) has existed for a very long time, and the counseling professions have made use of phone based contact for setting appointments, providing support between sessions, addressing crises, and even phone based counseling, for many decades. However, emerging technologies have created both new opportunities and new challenges for the manner in which these kinds of exchanges can occur between clients and mental health clinicians.

To begin with, the availability of high speed video streaming services allows clinicians to receive visual information about client interactions in real time over great distances. This permits teleconferencing based counseling to more closely approximate counseling done face to face. This has encouraged a much greater number of clinicians to consider providing services in this distance based format, and required the writing of new guidelines for how to do this in a legal and ethical way under state and federal laws and statutes, as well as under codes of ethics.

Concurrent to this, technological advancements in the development of smart phones have led to a major transition away from land line phones to cellular phone communication as the new normal. Smart phones with teleconferencing capabilities allow for the capacity to transmit and receive real time visual/audio interaction any time and practically anywhere.

However, the convenience and availability of these capabilities comes at the expense of the capacity to operate in private. Smart phones, which are, in essence, little computers, can have all of their actions tracked by those parties with ownership over the software that allows for the smart phone’s immense capabilities. Additionally, the microwave technology that carries phone signals to distant locations is susceptible to being intercepted by parties that have devices designed to pick up and listen in on those signals.

These considerations place cell phone communication in conflict with legal guidelines set forth in two important federal statutes: the Health Care Accountability and Affordability Act of 1996 (HIPAA) and the Hi-Tech act of 2010. These two laws define the degree to which people in the health professions must go to protect the private and personal information of their patients.

Because the commercial networks over which cell phones operate cannot be made sufficiently secure – without both the patient and the clinician possessing and using relatively expensive and complex encryption technology - cell phones are not considered HIPAA compliant. Wire to wire land line phones offer a much higher degree of privacy and are therefore more able to allow for communication that is in compliance with HIPAA guidelines.

This is a significant issue, since many clients do not even possess a land line phone, making it impossible to offer HIPAA compliant levels of privacy at the point of first contact with a client. Similar problems exist when communication with a client occurs via email. Unless the client and the clinician are communicating with encryption technology providing privacy protection at both origination points for the communication, then a potential HIPAA violation may exist.

There are different levels of remedy for these kinds of communication problems, allowing a conscientious clinician to address the privacy issues successfully. The remedies require both knowledge and forethought, but they can be implemented with a much higher degree of certainty, since the clinician is operating in the more closed systems in which these communication formats work. This is not necessarily the case when it comes to the more wide open arena of communication that takes place in social media platforms. This is the subject area that will be explored first.

The special risks and dangers that social networking sites pose for privacy are a function of the same factors that make social media such a powerful new force for shared communication and connection. For clinicians to know how to manage these risks and dangers, it may be helpful to provide a short overview of this area.

So what is a social network, and what is the importance of it for people in the mental health professions? What could be the uses – and dangers – of social networks for practitioners? The term “social network” has been in use since 1954, when anthropologist Professor J.A. Barnes coined the phrase to describe the complex relationships in a Norwegian fishing village. He concluded that the whole of social life could be viewed as a “set of points, some of which are joined by lines” to form a “total network” of social relations.

As most trainees know, online social networks, like Facebook, are internet websites which group individuals or organizations together into a network community for the purpose of socializing with friends and family, sharing common interests, or to network via the internet. Traditional social networking websites usually have open memberships, meaning that anyone can become a member, and do not focus on particular interests of the membership.

However, many social networking websites were formed to accommodate people with common interests such as hobbies, religion, or politics. The topics and interests represented by online social networks are widely varied, and are contained in sites developed within and outside of the United States.

One of the benefits of online social networks is that once granted access to a particular social networking website, members can socialize with each other by reading other members’ profile pages and may also communicate with other members in order to remain in contact with friends or make new acquaintances. Some people use online social networks to locate old friends, former classmates, and colleagues in order to reconnect, others to share information and experiences about all manner of activities, such as golfing, cooking, or gardening, developing professional alliances, finding employment, sharing business information, marketing products and services, etc.

Since the internet is available to people all around the world, social networking has also enabled the creation of connections and relationships between people from different cultures, creating interchanges of ideas and information, or the possibility of learning or practicing a new language. Many online social network sites have been developed by people in other countries, so that social networking can be conducted in their native languages.

In the mental health community, there have been some other uses of note. Support groups exist online, ranging from parenting and adoption groups, to addiction recovery groups. For individuals in recovery, technology can be used to instantaneously connect with numerous counterparts around the globe, which can provide a readily available online support system at any time of day or night. It remains to be seen whether the decrease in face-to- face contact through such traditional groups as A.A. or other mainstream recovery groups - due to people using online support groups - will have a negative impact on the power of recovery.

A number of mental health clinicians have posted their businesses/private practices on social networking sites. These clinicians use these sites as a way to promote their practices, make information available to prospective clients and potentially develop referrals to their practices, and to communicate and collaborate with other clinicians. Some clinicians are using social networks as one avenue for establishing themselves as experts in a particular field.

Social networking sites are powerful tools for reaching out to and connecting with potentially huge numbers of people. With the most popular social networks, there is virtually no limit as to the number of people who can be reached. The network is wide open, and almost anyone can join in the communication.

At the same time, the internet on which the social networks operate also offers a considerable degree of anonymity to anyone who desires it. People who choose to do so can acquire a good deal of the information posted on a social networking site without having to reveal their own identities to do so. Employers have begun to scrutinize social networking sites to gather information about the personal lives of their job applicants, looking for revelations to indicate that the potential employee might have beliefs or engage in behaviors that are incompatible with the mission or values of the organization to which they are applying. According to a CareerBuilders 2009 survey, 45% of employers engage in this kind of pre-screening practice through social network searches.

This combination of openness and anonymity is also one of the risks of the social networking sites. Whereas Facebook and other networking sites place a very high value on open exchanges of personal information, the mental health professions tend to be much more oriented towards the protection of privacy when it comes to important personal information. Exchanges of information with clients through social networking sites would therefore generate some problems in terms of privacy.

Additionally, mental health practitioners need to project a considerable degree of professional authority in their work. This professional authority is not always aided by clients having access to the personal information of a clinician. There are walls and boundaries between the personal life of the clinician and his/her clients that protect both the client and the clinician.

Herein lies the source of tension and conflict for mental health practitioners who choose to use social networking sites: there are competing purposes between the kind of openness envisioned and championed by social networks and the very private and confidential nature of the work done by mental health practitioners. The capacity of people to travel through the internet on a generally anonymous basis means that it is not even possible for clinicians to know whether clients are accessing the personal information that may be available on a social networking site.

This tension will form the core of this training program, and will inform a number of cautionary recommendations that will be made. First, it is always important to remain aware of with whom one is speaking online, just as one is careful about dealing with strangers in person. It is also advisable to protect personal information carefully by utilizing the privacy settings that are available on most social networking sites. As with any exchange of information, the consumer must beware.

The first consideration is both fundamental and obvious. It is always important to remain aware of with whom one is speaking online, just as one is careful about dealing with strangers in person. In the personal side of our lives as clinicians, we may have occasion to engage in acts that would not represent ourselves well if we were to introduce them into our clinical work with clients. The openness and anonymity of the internet means that we can’t always be sure whether our clients can see our actions in our more unguarded and personal moments.

Built into most social networking sites, there are mechanisms to mitigate this problem somewhat. It is always advisable to protect personal information carefully by utilizing the highest level of privacy settings that are available on most social networking sites. As with any exchange of information, however, the consumer must beware. There are limitations to how much privacy these security settings can guarantee in such an open system.

To drive this point home very clearly, some in the field are 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 who is the target of a lawsuit.

Although 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 information that 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 come back to haunt the poster months or even years after the fact. (Parish & Friedman, 2011)

Even as this course addresses the risks and dangers, care and effort has been put into helping clinicians understand the ways in which these risks and dangers can be reduced. It is not the position of this course that clinicians should completely forego social networking in order to avoid the inherent risks. There are enormous opportunities for this powerful new technology to be used for positive purposes.

However, the very particular nature of the work in the field of mental health requires that we approach innovations with clear eyes and reflective consideration, as opposed to a rush of application before the full impact has been evaluated. It is our hope that this course will provide the detailed background in this area that will allow clinicians to proceed with knowledge and understanding.