The following recommendations are offered for clinicians who decide to make use of social networking sites, whether as a professional or for personal pursuits.

1. Embrace new technology! Study new applications as they come available. One reason to do this is simply to keep up with the technology that clients are using and may discuss in therapy sessions. But another reason is that as new technologies develop, they may enhance clinical practice in ways that we can only imagine today. As it is, consider the changes that have taken place in the last ten years, including e-therapy, online support groups, how Google has become the go-to site for research on anything ranging from how to spell a word, to how to find a particular product, right on down to cooking recipes, and how to find a clinician who is a provider for a particular insurance company.


2. Check profile settings on social networking sites in order to limit access to those people whom you choose to allow to view your entire profile. Remember, however, there are limits to confidentiality. All it takes is one hacker, spy software program, or website security leak. In July 2010, a massive Facebook leak spilled private details of an estimated 100 million users into the internet after a highly publicized security “fix.” Also, many employers are now making use of web searches to determine the appropriateness of a potential employee. Spy software programs can send bogus emails to “friends” linked to your social network site, which can cause confusion and potentially damage relationships depending on the nature of the emails sent.

3. Take time and give thought to what you post and monitor content on your site regularly. Avoid posting photos that depict unprofessional behaviors. Avoid using social network sites to blow off steam about your boss, coworkers, or clients. These types of discussions need to take place in a confidential environment, such as clinical contacts longer have control over what they do with the information about you that they can access, nor can you control what they post on your site.

4. Adhere to the letter of the professional code of ethics as well as to its spirit. According to Frederic Reamer, doing something technically permissible does not mean that your actions might not result in being potentially harmful to clients. Practitioners who believe that they can discuss clients online by changing identifying information run up against codes of ethics stipulating that the dignity and worth of the client is sacrosanct. Sharing personal information about clients on line, even with identifying information changed, is clearly disrespectful of the client’s value, and is a blatant violation of the client’s trust. There is clear risk that the therapeutic process could be contaminated by this action. Even posting something like, “my clients gave me a rough time today,” is starting down a very risky path, and those types of discussions need to stay at the place of practice in order to be dealt with in a professionally appropriate manner. Behavioral Health practitioners have traditionally vented about their clients over the water cooler, which is just as inappropriate as venting over the internet.

5. Anyone who uses the internet leaves a trail. People who surf the net have a false sense of anonymous security. Law enforcement cases frequently document where subpoenaed accounts were tracked back to the poster. It is imperative that behavioral health practitioners proceed with great care when posting, with full understanding of the limits of confidentiality currently available on the internet.

6. Decline “Friend” requests from current and former clients. If current clients ask to “friend” you, decline politely and plan to discuss it in the next session. This is the same as a client inviting their therapist to a social function. It is never appropriate to befriend a client during or after therapy, simply because one never knows if the client will want to return to therapy at a later date. Be prepared with a standard response for clients, client friends/relatives, who request access to your personal profile, and be prepared to discuss this response in the next therapy session.

7. Avoid “Liking” groups or causes. It is important for therapists to remember that any opinions that they express online might become a topic in a client’s next therapy session.

8. When writing a blog, remain consistent with your public beliefs. Blogs are not the appropriate place for a therapist to vent about clients or their workplace. Those conversations are best served in clinical supervision. If a client were to read such a blog, it is entirely possible that it could ruin the therapeutic relationship. For a clinician who chooses to maintain a blog, it is important to be aware that clients can be negatively impacted by reading a blog that is counter to what the therapist espoused in session.

9. Google goes both ways. Clients who have access to the internet will likely Google their therapist, either as part of their research while searching for a practitioner, or after engaging in therapy when they may become curious about their therapist. This should not come as a surprise to anyone in practice, and provides an opportunity for a frank discussion of healthy boundaries. However, it’s a different story when therapists Google their clients. Some therapists justify this type of search as a way of verifying information provided by a client. However, that view undermines the very basis of the therapeutic relationship which relies on clients revealing information as they feel ready and safe.

10. Include a section on policies around social networking in clinical practice in Informed Consent documents. Of paramount importance is including information on the limits of confidentiality while using electronic means for communication. Use clear language. Be prepared to modify this section as new technologies emerge. While reviewing Informed Consent documents with clients, such as a Statement of Understanding or Statement of Services, allow adequate time to answer questions and engage in discussion about how the practice/agency handles communications from clients via electronic means, especially on social networking sites.

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